1760795306 NPI number — UNIQUE OPPORTUNITIES CASE MANAGEMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760795306 NPI number — UNIQUE OPPORTUNITIES CASE MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIQUE OPPORTUNITIES CASE MANAGEMENT
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:
1760795306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2325 SAN PEDRO NE
Provider Second Line Business Mailing Address:
SUITE 2D
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-830-5754
Provider Business Mailing Address Fax Number:
505-830-6907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 SAN PEDRO DR NE STE 2D
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:
87110-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-830-5754
Provider Business Practice Location Address Fax Number:
505-830-6907
Provider Enumeration Date:
07/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DEBACA
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
505-830-5754

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 81481578 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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