Healthcare Provider Details

I. General information

NPI: 1699425322
Provider Name (Legal Business Name): HEALING HANDS HOME HEALTH CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 ALVARADO DR NE STE 1
ALBUQUERQUE NM
87110-6502
US

IV. Provider business mailing address

534 CHARLESTON ST NE
ALBUQUERQUE NM
87108-2108
US

V. Phone/Fax

Practice location:
  • Phone: 505-389-0112
  • Fax:
Mailing address:
  • Phone: 505-347-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN DIXON
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-347-0877