Healthcare Provider Details

I. General information

NPI: 1023116548
Provider Name (Legal Business Name): INTELI-CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 VISTA OESTE NW STE 102
ALBUQUERQUE NM
87120-4340
US

IV. Provider business mailing address

2116 VISTA OESTE NW STE 102
ALBUQUERQUE NM
87120-4340
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-9745
  • Fax: 505-884-8667
Mailing address:
  • Phone: 505-898-9745
  • Fax: 505-884-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. ONESIMO C. VIGIL
Title or Position: CEO
Credential: BS, MBA
Phone: 505-898-9745