Healthcare Provider Details

I. General information

NPI: 1982528659
Provider Name (Legal Business Name): EXTRA MILE BUILDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 FLORAL RD NW
ALBUQUERQUE NM
87104
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE # 168
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-510-4182
  • Fax:
Mailing address:
  • Phone: 505-510-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: PAGE OLLICE
Title or Position: GENERAL MANAGER
Credential:
Phone: 505-510-4182