Healthcare Provider Details

I. General information

NPI: 1710399233
Provider Name (Legal Business Name): ALTERNATIVE DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ANTHONY DR
ANTHONY NM
88021-9371
US

IV. Provider business mailing address

PO BOX 2434
ANTHONY NM
88021-2434
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-3000
  • Fax:
Mailing address:
  • Phone: 575-882-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: LUCY E AGUILAR
Title or Position: OWNER
Credential:
Phone: 575-882-3000