Healthcare Provider Details

I. General information

NPI: 1285105932
Provider Name (Legal Business Name): CURRENT EDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9723 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2363
US

IV. Provider business mailing address

9723 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2363
US

V. Phone/Fax

Practice location:
  • Phone: 505-886-2025
  • Fax: 505-718-4976
Mailing address:
  • Phone: 505-886-2025
  • Fax: 505-718-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. RONAL SAMP JR.
Title or Position: PRESIDENT
Credential:
Phone: 505-886-2025