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Organization

RE-CYCLED MAN LLC

Active
Other names
A New Awakening Rio Rancho
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ERICK BRIAN PACHECO (OWNER)
(505) 489-4935
Entity
Organization

Contact information

Practice address
1207 GOLF COURSE RD SE, SUITE C, RIO RANCHO, NM 87124-1999
(505) 994-4100
(505) 994-1229
Mailing address
412 ASBURY RD NE, SUITE C, RIO RANCHO, NM 87124-5627
(505) 489-4935

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32D2113373
CLINICAL LABORATORY IMPROVMENT AMENDMENTS CERTIFICATE OF WAIVER
NM
05
93588755
NM
Enumeration date
10/13/2014
Last updated
07/05/2016
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