Healthcare Provider Details

I. General information

NPI: 1134597149
Provider Name (Legal Business Name): PATIENT CENTERED HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GIRARD BLVD SE
ALBUQUERQUE NM
87106-2229
US

IV. Provider business mailing address

205 GIRARD BLVD SE
ALBUQUERQUE NM
87106-2229
US

V. Phone/Fax

Practice location:
  • Phone: 505-459-3788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAN MCCLELLAN
Title or Position: OWNER
Credential: PT
Phone: 505-459-3788