Healthcare Provider Details

I. General information

NPI: 1518112655
Provider Name (Legal Business Name): ALTERNATIVE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 CANDELARIA RD NE STE 1B
ALBUQUERQUE NM
87112-1458
US

IV. Provider business mailing address

9809 CANDELARIA RD NE STE 1B
ALBUQUERQUE NM
87112-1458
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-9355
  • Fax: 505-237-0116
Mailing address:
  • Phone: 505-294-9355
  • Fax: 505-237-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET L HALL
Title or Position: OWNER/PRACTIONER
Credential: CKP,AHG,EKA
Phone: 505-294-9355