=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346282845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICARE HEALTH SERVICES CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 12/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 SUN AVE NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-468-4678
-----------------------------------------------------
Fax | 505-468-8013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 SUN AVE NE COMPLIANCE DEPARTMENT
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-468-5604
-----------------------------------------------------
Fax | 505-468-4681
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT-DIRECTOR
-----------------------------------------------------
Name | PETER NYLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-821-3355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | 1477
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number | 1477
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1477
-----------------------------------------------------
License Number State |
-----------------------------------------------------