Healthcare Provider Details

I. General information

NPI: 1275075509
Provider Name (Legal Business Name): ABSOLUTELY YOU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PILE ST
CLOVIS NM
88101-7538
US

IV. Provider business mailing address

301 PILE ST
CLOVIS NM
88101-7538
US

V. Phone/Fax

Practice location:
  • Phone: 575-631-3036
  • Fax:
Mailing address:
  • Phone: 575-631-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KONNIE KANMORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-631-3036