| Carlsbad Lifehouse Inc | |
|
1900 Westridge Rd Carlsbad NM 88220-3550 | |
| (575) 725-5552 | |
| (575) 725-5552 |
| Full Name | Carlsbad Lifehouse Inc |
|---|---|
| Speciality | Counselor |
| Location | 1900 Westridge Rd, Carlsbad, New Mexico |
| Authorized Official Name and Position | Kimberly Susan Rogge-rogers (EXECUTIVE ADMINISTRATOR) |
| Authorized Official Contact | 5753028304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlsbad Lifehouse Inc Po Box 3141 Carlsbad NM 88221-3141 Ph: (575) 302-8304 | Carlsbad Lifehouse Inc 1900 Westridge Rd Carlsbad NM 88220-3550 Ph: (575) 725-5552 |
| NPI Number | 1992398457 |
|---|---|
| Provider Enumeration Date | 02/16/2021 |
| Last Update Date | 12/30/2022 |
| Certification Date | 12/30/2022 |
| Medicare PECOS PAC ID | 0042602351 |
|---|---|
| Medicare Enrollment ID | O20220119000374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992398457 | NPI | - | NPPES |
| 24921327 | Medicaid | NY |
| Provider Name | Patricia G Anaya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366693996 PECOS PAC ID: 4789747601 Enrollment ID: I20090129000094 |
| Provider Name | Brent Schrader |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114952033 PECOS PAC ID: 9436129046 Enrollment ID: I20141015002241 |
| Provider Name | Sarah Marie Cordova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558875914 PECOS PAC ID: 7911399001 Enrollment ID: I20220124000304 |
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