Provider Demographics
NPI:1144013103
Name:CARLSBAD LIFEHOUSE INC
Entity type:Organization
Organization Name:CARLSBAD LIFEHOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:ROGGE-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-302-8304
Mailing Address - Street 1:1900 WESTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3550
Mailing Address - Country:US
Mailing Address - Phone:575-302-8304
Mailing Address - Fax:
Practice Address - Street 1:259 BLUEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-7305
Practice Address - Country:US
Practice Address - Phone:575-758-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE VISTA TAOS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility