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General NPI Number Information
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NPI Number | 1396066015
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Entity Type | Organization
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Legal Business Name | WHOLE STREAM ENTERPRISES, INC.
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 12/26/2011
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Provider Practice Location Address
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Address Line | 222 WILLOW RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-5839
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Country | US
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Telephone | 505-344-3465
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Fax | 505-344-0738
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Provider Business Mailing Address
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Address Line | 222 WILLOW RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-5839
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Country | US
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Telephone | 505-344-3465
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Fax | 505-344-0738
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Authorized Official
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Title or Position | MANAGER
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Name | KATHLEEN ERIN MALONE-GRIEGO
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Credential |
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Telephone | 505-344-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | ZRBL#20100402
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License Number State | NM
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