Healthcare Provider Details

I. General information

NPI: 1245354810
Provider Name (Legal Business Name): FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 MARBLE AVE NE STE 10
ALBUQUERQUE NM
87110-6641
US

IV. Provider business mailing address

5905 MARBLE AVE NE STE 10
ALBUQUERQUE NM
87110-6641
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-5084
  • Fax: 505-265-5301
Mailing address:
  • Phone: 505-265-5084
  • Fax: 505-265-5301

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: CREYO CAMPBELL
Title or Position: OWNER
Credential:
Phone: 505-265-5084