Organization
SUSAN'S LEGACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN WEIL PH.D. (EXECUTIVE DIRECTOR)
(505) 843-8450
Entity
Organization
Contact information
Practice address
8100 MOUNTAIN RD NE, SUITE 200, ALBUQUERQUE, NM 87110
(505) 843-8450
(505) 843-8449
Mailing address
11000 SPAIN NE, ALBUQUERQUE, NM 87111
(505) 843-8450
(505) 843-8449
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
0071091
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36873594
—
NM
01
—
NM600724
VALUE OPTIONS
NM
Enumeration date
10/22/2007
Last updated
05/06/2014
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