1194779322 NPI number — HOUSE CALLS OF NEW MEXICO LLC

Table of content: (NPI 1194779322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194779322 NPI number — HOUSE CALLS OF NEW MEXICO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSE CALLS OF NEW MEXICO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194779322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 WARRENVILLE RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-3400
Provider Business Mailing Address Fax Number:
630-487-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2129 OSUNA RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87113-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-884-4080
Provider Business Practice Location Address Fax Number:
505-944-0094
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DARBY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF STRATEGY OFFICER
Authorized Official Telephone Number:
630-296-3591

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30252776 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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