Healthcare Provider Details

I. General information

NPI: 1467213397
Provider Name (Legal Business Name): FLOR DE MARGARITA HOME CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7129 ISLETA BLVD. SW
ALBUQUERQUE NM
87105
US

IV. Provider business mailing address

PO BOX 72116
ALBUQUERQUE NM
87195
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-9343
  • Fax:
Mailing address:
  • Phone: 505-977-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ELIA ESPERANZA MALDONADO PEREZ
Title or Position: MEMBER
Credential:
Phone: 505-977-9343