Healthcare Provider Details

I. General information

NPI: 1598523920
Provider Name (Legal Business Name): COPPERTOP SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 INDUSTRIAL AVE NE
ALBUQUERQUE NM
87107-2283
US

IV. Provider business mailing address

13644 N RIM RD NE
ALBUQUERQUE NM
87112-6399
US

V. Phone/Fax

Practice location:
  • Phone: 505-721-9703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IAN COLLYER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-900-1933