Healthcare Provider Details

I. General information

NPI: 1841915386
Provider Name (Legal Business Name): 505 THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2117
US

IV. Provider business mailing address

4630 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2117
US

V. Phone/Fax

Practice location:
  • Phone: 505-361-1931
  • Fax:
Mailing address:
  • Phone: 505-361-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PHILIP HUNTER JOCHEM
Title or Position: CEO
Credential:
Phone: 214-714-1663