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EARTH SPIRIT AWAKENINGS LLC NPI 1447490800


NPI Information

NPI: 1447490800
Provider Name: EARTH SPIRIT AWAKENINGS LLC

Doing Business As: MESA VISTA WELLNESS

Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
ZIP 87507
Phone: (505) 983-8225
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EARTH SPIRIT AWAKENINGS LLC is a community behavioral health in Santa Fe, NM. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. EARTH SPIRIT AWAKENINGS LLC NPI is 1447490800. The provider is registered as an organization entity type.
The provider Is Doing Business As Mesa Vista Wellness.

The provider's business location address is:

4001 OFFICE COURT DR STE 102
SANTA FE, NM
ZIP 87507-903
Phone: (505) 983-8225

The provider's authorized official is Tod L Dicecco .
The authorized official title is Executive Director/owner and has the following contact phone number (505) 490-1984.

The enumeration date for this NPI number is 2/25/2009 and was last updated on 2/10/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthNo
2251S00000XCommunity/Behavioral Health0119891NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
181024371MEDICAIDNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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