Provider Demographics
NPI:1003118415
Name:ICU AT HOME, LLC
Entity Type:Organization
Organization Name:ICU AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORTEZ-FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:505-220-9184
Mailing Address - Street 1:8705 SILVERCREST CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6224
Mailing Address - Country:US
Mailing Address - Phone:505-321-5414
Mailing Address - Fax:
Practice Address - Street 1:8705 SILVERCREST CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6224
Practice Address - Country:US
Practice Address - Phone:505-321-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0096068251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care