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General NPI Number Information
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NPI Number | 1316091671
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HOME CARE
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1453 RIO RANCHO DR SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1837
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Country | US
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Telephone | 505-892-1830
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Fax | 505-896-1539
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Provider Business Mailing Address
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Address Line | 1453 RIO RANCHO DR SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1837
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Country | US
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Telephone | 505-892-1830
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Fax | 505-896-1539
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOE A GONZALEZ
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Credential | B.S., M.B.A.
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Telephone | 505-892-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0600098189
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License Number State | NM
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