1588032130 NPI number — SENSE-ABLE THERAPY LLC

Table of content: (NPI 1588032130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588032130 NPI number — SENSE-ABLE THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENSE-ABLE THERAPY 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:
1588032130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3017 CAMINO DE LA SIERRA NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87111-5601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-459-2180
Provider Business Mailing Address Fax Number:
505-212-0772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1751 BELLAMAH AVE NW
Provider Second Line Business Practice Location Address:
SUITE 1103
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87104-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-459-2180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KEENAN
Authorized Official First Name:
KRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER AND OWNER
Authorized Official Telephone Number:
505-459-2180

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2350 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 66536057 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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