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General NPI Number Information
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NPI Number | 1104632298
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Entity Type | Organization
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Legal Business Name | POMEGRANATE ORCHARDS LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 6921 MONTGOMERY BLVD NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1423
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Country | US
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Telephone | 505-373-3431
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Fax |
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Provider Business Mailing Address
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Address Line | 9706 CLAREMONT AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1424
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Country | US
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Telephone | 505-373-3431
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHRISTOPHER LOVE
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Credential |
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Telephone | 505-373-3431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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