Healthcare Provider Details

I. General information

NPI: 1386452001
Provider Name (Legal Business Name): YOUR PURPOSE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12844 LOMAS BLVD NE APT C6
ALBUQUERQUE NM
87112-6173
US

IV. Provider business mailing address

12844 LOMAS BLVD NE APT C6
ALBUQUERQUE NM
87112-6173
US

V. Phone/Fax

Practice location:
  • Phone: 505-539-9251
  • Fax: 505-600-3594
Mailing address:
  • Phone: 505-539-9251
  • Fax: 505-600-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MARES
Title or Position: OWNER
Credential:
Phone: 505-755-4747