Healthcare Provider Details

I. General information

NPI: 1972469112
Provider Name (Legal Business Name): AMMJO CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 ANDERSON RD NE
RIO RANCHO NM
87144-1483
US

IV. Provider business mailing address

3112 ANDERSON RD NE
RIO RANCHO NM
87144-1483
US

V. Phone/Fax

Practice location:
  • Phone: 202-706-0905
  • Fax:
Mailing address:
  • Phone: 202-706-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MBE TAYOURH
Title or Position: OWNER
Credential:
Phone: 832-252-9286