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General NPI Number Information
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NPI Number | 1447988399
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Entity Type | Organization
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Legal Business Name | FOUR BEARS, LLC
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 2425 DESERT VIEW RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-2636
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Country | US
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Telephone | 575-420-9562
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 DESERT VIEW RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-2636
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Country | US
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Telephone | 575-420-9562
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | MATTHEW NATHAN RAY
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Credential |
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Telephone | 505-208-0782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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