MEDICARE: MAKING AN IMPACT LLC

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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1407554439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKING AN IMPACT LLC

Provider Business Mailing Address
First Line	:	8601 GOLF COURSE RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 CHIHUAHUA RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-7758
Country	:	US
Telephone Number	:	505-305-0902
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	BROOKE SGUARDO
Credential	:
Telephone Number	:	480-299-2385

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	01/27/2026

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Directions to “MAKING AN IMPACT LLC ” Practice Location

Language	Start Address	Practice Location

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