Healthcare Provider Details

I. General information

NPI: 1376494856
Provider Name (Legal Business Name): BACA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CARLISLE BLVD NE STE 126
ALBUQUERQUE NM
87110-2979
US

IV. Provider business mailing address

2921 CARLISLE BLVD NE STE 125
ALBUQUERQUE NM
87110-2865
US

V. Phone/Fax

Practice location:
  • Phone: 505-601-6257
  • Fax: 505-554-1541
Mailing address:
  • Phone: 505-601-6257
  • Fax: 505-554-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAKEITHA C BURTON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 505-539-5290