Healthcare Provider Details

I. General information

NPI: 1215824917
Provider Name (Legal Business Name): SOUTHSTAR CAREGIVING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10727 BUCK ISLAND RD SW
ALBUQUERQUE NM
87121-2646
US

IV. Provider business mailing address

10727 BUCK ISLAND RD SW
ALBUQUERQUE NM
87121-2646
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-6601
  • Fax:
Mailing address:
  • Phone: 505-717-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage 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: SANDRA LOERA
Title or Position: BUSINESS PARTNER
Credential:
Phone: 505-507-0455