Healthcare Provider Details

I. General information

NPI: 1962537761
Provider Name (Legal Business Name): NAVITAS NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE SUITE 100
ALBUQUERQUE NM
87109-4397
US

IV. Provider business mailing address

9035 WADSWORTH PKWY SUITE 1000
WESTMINSTER CO
80021-8634
US

V. Phone/Fax

Practice location:
  • Phone: 303-865-7840
  • Fax:
Mailing address:
  • Phone: 303-865-7840
  • Fax: 303-865-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS RENEE RL TALBERT
Title or Position: BILLING AND TRAINING COORDINATOR
Credential:
Phone: 303-865-7840