Healthcare Provider Details

I. General information

NPI: 1124650817
Provider Name (Legal Business Name): UNITED ONE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321B CANDELARIA RD NE OFC 320
ALBUQUERQUE NM
87107-1908
US

IV. Provider business mailing address

512 EL SHADDAI ST NW
ALBUQUERQUE NM
87121-2571
US

V. Phone/Fax

Practice location:
  • Phone: 915-443-2836
  • Fax:
Mailing address:
  • Phone: 505-295-2044
  • Fax: 844-255-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MARIE MBAEZUE
Title or Position: OPERATIONS DIRECTOR
Credential: CSCM
Phone: 915-443-2836