Healthcare Provider Details

I. General information

NPI: 1972934743
Provider Name (Legal Business Name): ROADRUNNER HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 CORRALES RD SUITE A BUILDING A
CORRALES NM
87048
US

IV. Provider business mailing address

PO BOX 2046
CORRALES NM
87048-2046
US

V. Phone/Fax

Practice location:
  • Phone: 505-737-8213
  • Fax: 505-508-1514
Mailing address:
  • Phone: 505-321-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KECK
Title or Position: OWNER/CEO
Credential: BSN
Phone: 505-321-7295