Healthcare Provider Details

I. General information

NPI: 1265984868
Provider Name (Legal Business Name): URBANCARE HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2016
Last Update Date: 10/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 DUFFER LN
ANTHONY NM
88021-9319
US

IV. Provider business mailing address

1262 ONATE ST
ANTHONY NM
88021-7241
US

V. Phone/Fax

Practice location:
  • Phone: 915-472-0213
  • Fax:
Mailing address:
  • Phone: 915-472-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03357647005
License Number StateNM

VIII. Authorized Official

Name: AMANDA KING
Title or Position: CEO
Credential: RN
Phone: 915-472-0213