Healthcare Provider Details

I. General information

NPI: 1114094901
Provider Name (Legal Business Name): CRITICAL AIR RESPONSE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 WYOMING BLVD NE SUITE 105
ALBUQUERQUE NM
87109-3148
US

IV. Provider business mailing address

5345 WYOMING BLVD NE SUITE 105
ALBUQUERQUE NM
87109-3148
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-7760
  • Fax: 505-821-1113
Mailing address:
  • Phone: 505-242-7760
  • Fax: 505-821-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberF00031
License Number StateNM

VIII. Authorized Official

Name: JAKE JACOBSEN
Title or Position: MANAGING MEMBER
Credential:
Phone: 505-463-1543