Provider Demographics
NPI:1316638232
Name:CIELITO LINDO WAIVER SERVICES, LLC
Entity type:Organization
Organization Name:CIELITO LINDO WAIVER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-920-6031
Mailing Address - Street 1:2327 CALLE REINA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6909
Mailing Address - Country:US
Mailing Address - Phone:505-920-6031
Mailing Address - Fax:
Practice Address - Street 1:2327 CALLE REINA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6909
Practice Address - Country:US
Practice Address - Phone:505-920-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty