=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639514342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAKECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2013
-----------------------------------------------------
Last Update Date | 05/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12231 ACADEMY RD NE #301-231
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-7236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-944-5695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12231 ACADEMY RD NE #301-231
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-7236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARC STERNHAGEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-944-5695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 3400
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------