Healthcare Provider Details

I. General information

NPI: 1891562849
Provider Name (Legal Business Name): ACCREDO CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KENNEDY RD
LAS CRUCES NM
88007-5761
US

IV. Provider business mailing address

PO BOX 13372
LAS CRUCES NM
88013-3372
US

V. Phone/Fax

Practice location:
  • Phone: 575-232-7460
  • Fax: 575-223-0769
Mailing address:
  • Phone: 575-232-7460
  • Fax: 575-223-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO JOSHUA VALENZUELA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 575-232-7460