Healthcare Provider Details

I. General information

NPI: 1407178387
Provider Name (Legal Business Name): HOGARES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 LOUISIANA BLVD SE
ALBUQUERQUE NM
87108-3842
US

IV. Provider business mailing address

1218 GRIEGOS RD NW
ALBUQUERQUE NM
87107-3752
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0492
  • Fax:
Mailing address:
  • Phone: 505-345-8471
  • Fax: 505-342-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1001YM0800X
License Number StateNM

VIII. Authorized Official

Name: AUDREY MITCHELL
Title or Position: HR SPECIALIST
Credential:
Phone: 505-342-5489