Healthcare Provider Details

I. General information

NPI: 1912273251
Provider Name (Legal Business Name): ALMA HOME HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8216 PERIDOT AVE SW
ALBUQUERQUE NM
87121-8334
US

IV. Provider business mailing address

8216 PERIDOT AVE SW
ALBUQUERQUE NM
87121-8334
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-5984
  • Fax: 505-717-2472
Mailing address:
  • Phone: 505-907-5984
  • Fax: 505-717-2472

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNIE DWAYNE HICKS IV
Title or Position: OWNER
Credential: LVN,DSD, INSTRUCTOR
Phone: 505-907-5984