Provider Demographics
NPI:1073134011
Name:SUPERHEALTH, INC.
Entity Type:Organization
Organization Name:SUPERHEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUKTA
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-699-6505
Mailing Address - Street 1:19 LUMBRE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-6701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 LUMBRE DEL SOL
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-6701
Practice Address - Country:US
Practice Address - Phone:505-699-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty