Provider Demographics
NPI:1124466446
Name:SHEKINAH FOUNDATION
Entity type:Organization
Organization Name:SHEKINAH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:575-578-9450
Mailing Address - Street 1:3001 S WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-2326
Mailing Address - Country:US
Mailing Address - Phone:575-578-9450
Mailing Address - Fax:
Practice Address - Street 1:3001 S WYOMING AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-2326
Practice Address - Country:US
Practice Address - Phone:575-578-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-08
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty