Healthcare Provider Details

I. General information

NPI: 1780728261
Provider Name (Legal Business Name): ST. ANTHONY'S HOME HEALTHCARE SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE B480
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

8500 MENAUL BLVD NE B480
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-9618
  • Fax: 505-883-2931
Mailing address:
  • Phone: 505-888-9618
  • Fax: 505-883-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPT0061481
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BROWN
Title or Position: OWNER
Credential:
Phone: 505-888-9618