Interfaith Leap, Inc.
NPI #1770960064 in Pena Blanca, New Mexico
Provider Information
- NPI Number
- 1770960064
- Entity Type
- Organization
- Organization Name
- Interfaith Leap, Inc.
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Enumeration Date
- May 6, 2015
- Last Updated
- Jul 20, 2015
Practice Location
- Address
- 816 HIGHWAY 22
- City
- Pena Blanca
- State
- New Mexico
- ZIP Code
- 87041
- Phone
- (505) 470-2887
Authorized Official
- Name
- LAWRENCE A MEDINA
- Title
- EXECUTIVE DIRECTOR
- Phone
- (505) 470-2887
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
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