Healthcare Provider Details

I. General information

NPI: 1477958809
Provider Name (Legal Business Name): BEST BUDDIES INTERNATIONAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 WYOMING BLVD NE STE A
ALBUQUERQUE NM
87111-4433
US

IV. Provider business mailing address

3507 WYOMING BLVD NE STE A
ALBUQUERQUE NM
87111-4433
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-2552
  • Fax:
Mailing address:
  • Phone: 505-299-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number12923541
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JILL FRANK
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 305-374-2244