Healthcare Provider Details

I. General information

NPI: 1881750677
Provider Name (Legal Business Name): LEAVITT ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 CLINTON BLVD SW
ALBUQUERQUE NM
87105-6122
US

IV. Provider business mailing address

4005 CLINTON BLVD SW
ALBUQUERQUE NM
87105-6122
US

V. Phone/Fax

Practice location:
  • Phone: 505-877-3627
  • Fax: 505-877-0627
Mailing address:
  • Phone: 505-877-3627
  • Fax: 505-877-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number03019401006
License Number StateNM

VIII. Authorized Official

Name: MRS. PATSY E LEAVITT
Title or Position: OWNER
Credential: RN RETIRED
Phone: 505-877-3627