Healthcare Provider Details

I. General information

NPI: 1396066015
Provider Name (Legal Business Name): WHOLE STREAM ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 12/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WILLOW RD NW
ALBUQUERQUE NM
87107-5839
US

IV. Provider business mailing address

222 WILLOW RD NW
ALBUQUERQUE NM
87107-5839
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-3465
  • Fax: 505-344-0738
Mailing address:
  • Phone: 505-344-3465
  • Fax: 505-344-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberZRBL#20100402
License Number StateNM

VIII. Authorized Official

Name: KATHLEEN ERIN MALONE-GRIEGO
Title or Position: MANAGER
Credential:
Phone: 505-344-3465