Healthcare Provider Details

I. General information

NPI: 1902164585
Provider Name (Legal Business Name): NEW MEXICO SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

IV. Provider business mailing address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-0701
  • Fax:
Mailing address:
  • Phone: 505-268-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberR24768
License Number StateNM

VIII. Authorized Official

Name: DR. NICOLE ANDERSON
Title or Position: TREATMENT TEAM LEADER
Credential: PHD
Phone: 505-268-0701