Healthcare Provider Details

I. General information

NPI: 1194868943
Provider Name (Legal Business Name): ANGEL CARE OF NEW MEXICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S WALNUT ST STE C1
LAS CRUCES NM
88001-2617
US

IV. Provider business mailing address

151 S WALNUT ST STE C1
LAS CRUCES NM
88001-2617
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-2080
  • Fax:
Mailing address:
  • Phone: 505-521-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberD4361
License Number StateNM

VIII. Authorized Official

Name: ANGELA LEDESMA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-521-2080