Provider Demographics
NPI:1750448056
Name:LA VIDA FELICIDAD, INC.
Entity Type:Organization
Organization Name:LA VIDA FELICIDAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ISAIAS
Authorized Official - Last Name:MONDRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-565-1614
Mailing Address - Street 1:PO BOX 2040
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-2040
Mailing Address - Country:US
Mailing Address - Phone:505-565-1614
Mailing Address - Fax:505-565-1608
Practice Address - Street 1:530 SUN RANCH VILLAGE LOOP SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4809
Practice Address - Country:US
Practice Address - Phone:505-565-1614
Practice Address - Fax:505-565-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5604251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ7498Medicaid
NMD1246Medicaid
NME7184Medicaid