Healthcare Provider Details

I. General information

NPI: 1912726415
Provider Name (Legal Business Name): MAHBASI HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 B HARKLE RD SUIT 100
SANTA FE NM
87505
US

IV. Provider business mailing address

530 B HARKLE RD SUIT 100
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-4834
  • Fax:
Mailing address:
  • Phone: 505-702-4834
  • 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: ABDUL-SALAM AL-HASSAN
Title or Position: MANAGER
Credential: RN
Phone: 505-702-4834