Healthcare Provider Details

I. General information

NPI: 1366987653
Provider Name (Legal Business Name): RETREAT HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 ACADEMY PARKWAY NORTH NE
ALBUQUERQUE NM
87109-4409
US

IV. Provider business mailing address

3812 ACADEMY PARKWAY NORTH NE
ALBUQUERQUE NM
87109-4409
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-2490
  • 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: ROBERT W METZ
Title or Position: OWNER
Credential:
Phone: 505-217-2490