MEDICARE: ACTIVE ADVOCATES OF NEW MEXICO LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861112534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE ADVOCATES OF NEW MEXICO LLC

Provider Business Mailing Address
First Line	:	9301 INDIAN SCHOOL RD NE STE 200D
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2877
Country	:	US
Telephone Number	:	505-353-1778
Fax Number	:	505-214-5154

Provider Business Practice Location Address
First Line	:	9301 INDIAN SCHOOL RD NE STE 200D
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2877
Country	:	US
Telephone Number	:	505-353-1778
Fax Number	:	505-214-5154

Authorized Official
Title or Position	:	OWNER/CONSULTANT
Name	:	ALICIA R SISNEROS
Credential	:
Telephone Number	:	505-353-1778

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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