Healthcare Provider Details

I. General information

NPI: 1811014657
Provider Name (Legal Business Name): PROFESSIONAL CASE COORDINATION AND CONSULTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5773 TOSCA RD NW
ALBUQUERQUE NM
87114-3857
US

IV. Provider business mailing address

PO BOX 67216
ALBUQUERQUE NM
87193-7216
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-3708
  • Fax: 505-508-1214
Mailing address:
  • Phone: 505-715-3708
  • Fax: 505-508-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: DANIEL PAUL ROMERO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-715-3708