Healthcare Provider Details

I. General information

NPI: 1316091671
Provider Name (Legal Business Name): BEHAVIORAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 RIO RANCHO DR SE STE C
RIO RANCHO NM
87124-1837
US

IV. Provider business mailing address

1453 RIO RANCHO DR SE STE C
RIO RANCHO NM
87124-1837
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-1830
  • Fax: 505-896-1539
Mailing address:
  • Phone: 505-892-1830
  • Fax: 505-896-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0600098189
License Number StateNM

VIII. Authorized Official

Name: MR. JOE A GONZALEZ
Title or Position: PRESIDENT
Credential: B.S., M.B.A.
Phone: 505-892-1830