MEDICARE: ABODE HOSPICE OF NEW MEXICO, LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1790410777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABODE HOSPICE OF NEW MEXICO, LLC

Provider Business Mailing Address
First Line	:	5600 EUBANK BLVD NE STE 120
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1555
Country	:	US
Telephone Number	:	505-322-6028
Fax Number	:	505-322-6251

Provider Business Practice Location Address
First Line	:	5600 EUBANK BLVD NE STE 120
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1555
Country	:	US
Telephone Number	:	505-322-6028
Fax Number	:	505-322-6251

Authorized Official
Title or Position	:	SECRETARY
Name	:	KEVIN MCDANIEL
Credential	:
Telephone Number	:	256-810-1079

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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