MEDICARE: CHIRON'S CAVE HOLISTIC 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609657519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRON'S CAVE HOLISTIC LLC

Provider Business Mailing Address
First Line	:	2103 GOLF COURSE RD SE STE A
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1764
Country	:	US
Telephone Number	:	541-919-4404
Fax Number	:	541-248-1147

Provider Business Practice Location Address
First Line	:	2103 GOLF COURSE RD SE STE A
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1764
Country	:	US
Telephone Number	:	541-919-4404
Fax Number	:	541-248-1147

Authorized Official
Title or Position	:	OWNER
Name	:	CHRIS M LOMBARDO
Credential	:	LPCC
Telephone Number	:	541-919-4404

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	08/12/2024

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