MEDICARE: THE HEALING SANCTUARY, 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	225800000X	Recreation Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497625206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALING SANCTUARY, LLC

Provider Business Mailing Address
First Line	:	2000 GLEMMWAY PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-6828
Country	:	US
Telephone Number	:	915-996-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 MATTOX ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1307
Country	:	US
Telephone Number	:	915-996-2776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALYSSA GARY
Credential	:	CTRS
Telephone Number	:	575-520-5166

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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