Healthcare Provider Details

I. General information

NPI: 1194491209
Provider Name (Legal Business Name): HOSPICE OF THE SOUTHWEST ALBQ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 FAIRFAX DR NW
ALBUQUERQUE NM
87114-4661
US

IV. Provider business mailing address

5219 FAIRFAX DR NW
ALBUQUERQUE NM
87114-4661
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-1039
  • Fax:
Mailing address:
  • Phone: 505-903-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSIE J PANN-NAVA
Title or Position: SECRETARY
Credential: AAS
Phone: 505-903-1039