Healthcare Provider Details

I. General information

NPI: 1003118415
Provider Name (Legal Business Name): ICU AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 SILVERCREST CT NW
ALBUQUERQUE NM
87114-6224
US

IV. Provider business mailing address

8705 SILVERCREST CT NW
ALBUQUERQUE NM
87114-6224
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-5414
  • Fax:
Mailing address:
  • Phone: 505-321-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberFA0096068
License Number StateNM

VIII. Authorized Official

Name: FRANCISCA A CORTEZ-FRANKEL
Title or Position: NURSE MANAGER
Credential: BSN
Phone: 505-220-9184