Healthcare Provider Details

I. General information

NPI: 1366270670
Provider Name (Legal Business Name): HORIZON HEALTHCARE OF NEW MEXICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 MOUNTAIN ROAD PL NE STE R
ALBUQUERQUE NM
87110-7845
US

IV. Provider business mailing address

217 WISCONSIN AVE STE 201
WAUKESHA WI
53186-4946
US

V. Phone/Fax

Practice location:
  • Phone: 414-376-5577
  • Fax:
Mailing address:
  • Phone: 414-376-5577
  • Fax: 414-762-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARL RAJANI
Title or Position: PRESIDENT
Credential:
Phone: 414-581-0582