Prospera Healthcare New Mexico LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROSPERA HEALTHCARE NEW MEXICO LLC

Practice address

9701 Montgomery Blvd NE
Albuquerque, NM 87111-3501

Phone

(972) 900-2488

NPI assigned

Mar 23, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Coddington

Title

Founder

Phone

(972) 400-1983

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1083363295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SADDLE DR",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750286011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113501",
            "telephone_number": "972-900-2488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPERA HEALTHCARE NEW MEXICO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "CODDINGTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "972-400-1983"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.