MEDICARE: ALIVE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	PTO129672	NM

General Provider Information

NPI Number	:	1730515230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIVE INC.

Provider Business Mailing Address
First Line	:	901 RIO GRANDE BLVD NW
Second Line	:	SUITE H260
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2057
Country	:	US
Telephone Number	:	505-896-8509
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 RIO GRANDE BLVD NW
Second Line	:	SUITE H260
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2057
Country	:	US
Telephone Number	:	505-896-8509
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAWNETTE BURNS
Credential	:
Telephone Number	:	505-896-8509

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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Directions to “ALIVE INC. ” Practice Location

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