Organization
INTERFAITH LEAP, INC.
Active
Other names
Sangre De Cristo Center
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE A MEDINA (EXECUTIVE DIRECTOR)
(505) 470-2887
Entity
Organization
Contact information
Practice address
816 HIGHWAY 22, PENA BLANCA, NM 87041
(505) 470-2887
Mailing address
PO BOX 1270, PENA BLANCA, NM 87041-1270
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/06/2015
Last updated
07/20/2015
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