1063799179 NPI number — ABANZA PESONAL CARE SERVICES II LLC

Table of content: (NPI 1063799179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063799179 NPI number — ABANZA PESONAL CARE SERVICES II LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABANZA PESONAL CARE SERVICES II 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:
1063799179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTHONY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88021-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-882-1899
Provider Business Mailing Address Fax Number:
575-882-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 ANTHONY DR
Provider Second Line Business Practice Location Address:
SUITE # 3
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88021-1297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-882-1899
Provider Business Practice Location Address Fax Number:
575-882-1949
Provider Enumeration Date:
11/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
CLARA
Authorized Official Middle Name:
ZULMA
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
505-554-1012

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  88575063 , 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)





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