Healthcare Provider Details

I. General information

NPI: 1730515230
Provider Name (Legal Business Name): ALIVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW SUITE H260
ALBUQUERQUE NM
87104-2057
US

IV. Provider business mailing address

901 RIO GRANDE BLVD NW SUITE H260
ALBUQUERQUE NM
87104-2057
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-8509
  • Fax:
Mailing address:
  • Phone: 505-896-8509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberPTO129672
License Number StateNM

VIII. Authorized Official

Name: DAWNETTE BURNS
Title or Position: PRESIDENT
Credential:
Phone: 505-896-8509