Organization
ENCHANTED HEALING OF NEW MEXICO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DELASARIA LIHON L.I.S.W. (OWNER/DIRECTOR)
(505) 362-5847
Entity
Organization
Contact information
Practice address
122 BRYN MAWR DR SE, ALBUQUERQUE, NM 87106-2210
(505) 362-5847
(201) 530-8616
Mailing address
21 KUHN DR, TIJERAS, NM 87059-8101
(505) 362-5847
(201) 530-8616
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
I-06142
NM
251S00000X
Community/Behavioral Health Agency
Primary
I-06142
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55088279
—
NM
Enumeration date
03/30/2011
Last updated
03/31/2011
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