Healthcare Provider Details

I. General information

NPI: 1063799179
Provider Name (Legal Business Name): ABANZA PESONAL CARE SERVICES II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 ANTHONY DR SUITE # 3
ANTHONY NM
88021-1297
US

IV. Provider business mailing address

PO BOX 1297
ANTHONY NM
88021-1297
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-1899
  • Fax: 575-882-1949
Mailing address:
  • Phone: 575-882-1899
  • Fax: 575-882-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number88575063
License Number StateNM

VIII. Authorized Official

Name: MRS. CLARA ZULMA VALDEZ
Title or Position: CO-OWNER
Credential:
Phone: 505-554-1012