MEDICARE: A CENTER FOR FUNCTION AND CREATIVITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	75988721	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386933620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A CENTER FOR FUNCTION AND CREATIVITY

Provider Business Mailing Address
First Line	:	10701 CORRALES BLVD NW
Second Line	:	SUITE 17
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-1087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 CORRALES BLVD NW
Second Line	:	SUITE 17
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-1087
Country	:	US
Telephone Number	:	505-890-0868
Fax Number	:	505-898-0169

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT HOBBS
Credential	:
Telephone Number	:	505-890-0868

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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