Provider Demographics
NPI:1104560507
Name:UNDER HIS CONSTRUCTION
Entity type:Organization
Organization Name:UNDER HIS CONSTRUCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LIA
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPSW
Authorized Official - Phone:505-814-4747
Mailing Address - Street 1:PO BOX 81005
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87198-1005
Mailing Address - Country:US
Mailing Address - Phone:505-814-4747
Mailing Address - Fax:
Practice Address - Street 1:4700 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1225
Practice Address - Country:US
Practice Address - Phone:505-814-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health