1801186069 NPI number — RESILIENCE INTEGRATIVE SERVICES LLC

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 1801186069 NPI number — RESILIENCE INTEGRATIVE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESILIENCE INTEGRATIVE SERVICES 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:
1801186069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5212 PARK HEIGHTS RD NW
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:
87120-4726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 VIRGINIA ST NE
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-1093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-977-3112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BACA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
FRANCES
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
505-315-7397

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  0983 , 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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