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NPI Code Detail

MEDICARE: LIFEHOUSE VISTA TAOS

MEDICARE: LIFEHOUSE VISTA TAOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144013103
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEHOUSE VISTA TAOS
Provider Business Mailing Address
First Line : PO BOX 3141
Second Line :
City : CARLSBAD
State : NM
Zip : 88221-3141
Country : US
Telephone Number : 575-302-8304
Fax Number :
Provider Business Practice Location Address
First Line : 259 BLUEBERRY HILL RD
Second Line :
City : EL PRADO
State : NM
Zip : 87529-7305
Country : US
Telephone Number : 575-758-5858
Fax Number :
Authorized Official
Title or Position : EXECUTIVE ADMINISTRATOR
Name : KIMBERLY SUSAN ROGGE-ROGERS
Credential :
Telephone Number : 575-302-8304
Provider Enumeration Date : 05/23/2025
Last Update Date : 02/24/2026

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Directions to “LIFEHOUSE VISTA TAOS ” Practice Location

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