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NPI Code Detail

MEDICARE: MENDING HEARTS, LLC

MEDICARE: MENDING HEARTS, 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
11041C0700XClinical Social WorkerC-09284NM

General Provider Information

NPI Number : 1487100392
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDING HEARTS, LLC
Provider Business Mailing Address
First Line : 1305 SAN LORENZO AVE NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-3427
Country : US
Telephone Number : 505-903-5437
Fax Number : 505-344-2104
Provider Business Practice Location Address
First Line : 3939 SAN PEDRO DR NE BLDG B1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-8903
Country : US
Telephone Number : 505-440-7600
Fax Number : 505-344-2104
Authorized Official
Title or Position : OWNER
Name : NIKKA PERALTA
Credential : LCSW
Telephone Number : 505-903-5437
Provider Enumeration Date : 08/31/2016
Last Update Date : 08/01/2024

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Directions to “MENDING HEARTS, LLC ” Practice Location

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