Provider Demographics
NPI:1336489772
Name:MAKING LIFE SMILE ORGANIZATION, CORPORATION
Entity Type:Organization
Organization Name:MAKING LIFE SMILE ORGANIZATION, CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:505-312-8815
Mailing Address - Street 1:3301 WELLESLEY CT NE APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4455
Mailing Address - Country:US
Mailing Address - Phone:505-312-8815
Mailing Address - Fax:505-212-0991
Practice Address - Street 1:3301 WELLESLEY CT NE APT 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4455
Practice Address - Country:US
Practice Address - Phone:505-312-8815
Practice Address - Fax:505-212-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96645OtherMEDICARE AUDITOR
NMNPN738876OtherINSURANCE LICENSE
NMP131539OtherCERTIFIED PUBLIC ACCOUNTANT