Organization
EXPRESSIONS OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL LYNN MONTOYA-HERRERA (DIRECTOR)
(505) 831-6250
Entity
Organization
Contact information
Practice address
3811 ATRISCO DR NW STE C, ALBUQUERQUE, NM 87120-4903
(505) 831-6250
(505) 831-6254
Mailing address
3811 ATRISCO DR NW STE C, ALBUQUERQUE, NM 87120-4903
(505) 831-6250
(505) 831-6254
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
02-942112-00-8
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0413
—
NM
Enumeration date
07/15/2006
Last updated
08/22/2020
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