Healthcare Provider Details

I. General information

NPI: 1144309741
Provider Name (Legal Business Name): ZIMMERMAN CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 ROMERO RD
LOS LUNAS NM
87031-7624
US

IV. Provider business mailing address

15 JEMEZ DR.
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-9271
  • Fax: 505-866-9278
Mailing address:
  • Phone: 505-866-9271
  • Fax: 505-866-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1098 & 1112
License Number StateNM

VIII. Authorized Official

Name: KEVIN ALEXY
Title or Position: FISCAL OPERATIONS MANAGER
Credential:
Phone: 505-866-9271