Provider Demographics
NPI:1083471551
Name:LIFE RE-CREATED, LLC
Entity Type:Organization
Organization Name:LIFE RE-CREATED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-264-4082
Mailing Address - Street 1:PO BOX 45681
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-5681
Mailing Address - Country:US
Mailing Address - Phone:505-226-1960
Mailing Address - Fax:505-672-7769
Practice Address - Street 1:713 ALVARADO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3624
Practice Address - Country:US
Practice Address - Phone:505-264-4082
Practice Address - Fax:833-964-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty