Provider Demographics
NPI:1114509437
Name:LIFESPHERE LLC
Entity Type:Organization
Organization Name:LIFESPHERE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADONATA
Authorized Official - Middle Name:
Authorized Official - Last Name:PYAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-983-0693
Mailing Address - Street 1:5 BISBEE CT STE 109
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1419
Mailing Address - Country:US
Mailing Address - Phone:505-983-0693
Mailing Address - Fax:505-393-3070
Practice Address - Street 1:532 DON GASPAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2626
Practice Address - Country:US
Practice Address - Phone:505-983-0693
Practice Address - Fax:505-393-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health