Healthcare Provider Details

I. General information

NPI: 1649757030
Provider Name (Legal Business Name): ALLEGIANCE PREMIER HOME HEALTHCARE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 VISTA ESTE NE
RIO RANCHO NM
87124-4783
US

IV. Provider business mailing address

PO BOX 44187
RIO RANCHO NM
87174-4187
US

V. Phone/Fax

Practice location:
  • Phone: 505-870-3271
  • Fax: 877-349-7961
Mailing address:
  • Phone: 505-870-3271
  • Fax: 877-349-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3409
License Number StateNM

VIII. Authorized Official

Name: MRS. AMBER DAWN GURULE
Title or Position: RN-OWNER
Credential: RN
Phone: 505-870-3271