Organization
PROSPERA HEALTHCARE NEW MEXICO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE CODDINGTON (FOUNDER)
(972) 400-1983
Entity
Organization
Contact information
Practice address
9701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87111-3501
(972) 900-2488
Mailing address
5200 SADDLE DR, FLOWER MOUND, TX 75028-6011
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
03/23/2022
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