Healthcare Provider Details

I. General information

NPI: 1003091521
Provider Name (Legal Business Name): WW HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LOUISIANA BLVD NE
ALBUQUERQUE NM
87108-2051
US

IV. Provider business mailing address

500 LOUISIANA BLVD NE
ALBUQUERQUE NM
87108-2051
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1717
  • Fax:
Mailing address:
  • Phone: 505-255-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1077
License Number StateNM

VIII. Authorized Official

Name: MR. HORACE WINCHESTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 312-255-1514