Provider Demographics
NPI:1285007724
Name:SAM'S WISHE'S INC
Entity Type:Organization
Organization Name:SAM'S WISHE'S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEHR
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-948-1811
Mailing Address - Street 1:6200 EUBANK BLVD. NE
Mailing Address - Street 2:712
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-948-1811
Mailing Address - Fax:
Practice Address - Street 1:6200 EUBANK BLVD NE
Practice Address - Street 2:712
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7379
Practice Address - Country:US
Practice Address - Phone:505-948-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0166301251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health