# INTERFAITH LEAP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sangre De Cristo Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770960064
- **Authorized official:** LAWRENCE A MEDINA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (505) 470-2887

## Contact information

- **Practice address:** 816 HIGHWAY 22, PENA BLANCA, NM 87041
- **Practice address phone:** (505) 470-2887
- **Mailing address:** PO BOX 1270, PENA BLANCA, NM 87041-1270

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 05/06/2015
- **Last updated:** 07/20/2015