| Umoja Behavioral Health Pc | |
|
3150 Carlisle Blvd Ne Ste 110 Albuquerque NM 87110-1681 | |
| (505) 672-5598 | |
| (505) 214-5071 |
| Full Name | Umoja Behavioral Health Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3150 Carlisle Blvd Ne Ste 110, Albuquerque, New Mexico |
| Authorized Official Name and Position | Kenneth B Winfrey (OWNER) |
| Authorized Official Contact | 5056636645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Umoja Behavioral Health Pc 3150 Carlisle Blvd Ne Ste 105 Albuquerque NM 87110-1680 Ph: (505) 663-8173 | Umoja Behavioral Health Pc 3150 Carlisle Blvd Ne Ste 110 Albuquerque NM 87110-1681 Ph: (505) 672-5598 |
| NPI Number | 1063989648 |
|---|---|
| Provider Enumeration Date | 11/01/2018 |
| Last Update Date | 02/23/2022 |
| Certification Date | 02/23/2022 |
| Medicare PECOS PAC ID | 9537400148 |
|---|---|
| Medicare Enrollment ID | O20190409001718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063989648 | NPI | - | NPPES |
| Provider Name | Lisa Marie Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548513716 PECOS PAC ID: 0547409005 Enrollment ID: I20130614000062 |
| Provider Name | Kenneth Bruce Winfrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649500554 PECOS PAC ID: 3274894779 Enrollment ID: I20180226000592 |
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