Healthcare Provider Details

I. General information

NPI: 1174861942
Provider Name (Legal Business Name): ALBUQUERQUE COMPLETE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 ACADEMY PARKWAY NORTH NE
ALBUQUERQUE NM
87109-4409
US

IV. Provider business mailing address

3812 ACADEMY PARKWAY NORTH NE
ALBUQUERQUE NM
87109-4409
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-7431
  • Fax: 855-427-2693
Mailing address:
  • Phone: 505-938-7431
  • Fax: 855-427-2693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number89-87
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86-083
License Number StateNM

VIII. Authorized Official

Name: ROBERT W METZ
Title or Position: CFO
Credential:
Phone: 505-217-2490