Healthcare Provider Details

I. General information

NPI: 1891173100
Provider Name (Legal Business Name): HEALTHSEQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST SUITE B5
SANTA FE NM
87505-2138
US

IV. Provider business mailing address

2074 GALISTEO ST SUITE B5
SANTA FE NM
87505-2138
US

V. Phone/Fax

Practice location:
  • Phone: 505-362-3500
  • Fax:
Mailing address:
  • Phone: 505-362-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RON BACA
Title or Position: PRESIDENT
Credential:
Phone: 505-362-3500