Healthcare Provider Details

I. General information

NPI: 1649524950
Provider Name (Legal Business Name): MISSIONARY OF SISTERS OF THE BLESSED SACRAMENT - SBS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOMAS BLVD NE STE 101
ALBUQUERQUE NM
87112-5401
US

IV. Provider business mailing address

10801 LOMAS BLVD NE STE 101
ALBUQUERQUE NM
87112-5401
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-6453
  • Fax:
Mailing address:
  • Phone: 505-717-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3418
License Number StateNM

VIII. Authorized Official

Name: ANGELA AKUAGBOGU
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-717-6453