Healthcare Provider Details

I. General information

NPI: 1053193318
Provider Name (Legal Business Name): ALLSTAR PERSONAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CARLISLE BLVD NE STE 119
ALBUQUERQUE NM
87110-2864
US

IV. Provider business mailing address

2235 ALEXANDRA LN
BELEN NM
87002-8083
US

V. Phone/Fax

Practice location:
  • Phone: 505-539-5290
  • Fax: 888-503-7522
Mailing address:
  • Phone: 719-491-8173
  • Fax: 888-503-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKEITHA C BURTON
Title or Position: OWNER
Credential:
Phone: 505-539-5290