Provider Demographics
NPI:1043324221
Name:GONZALES FAMILY, INC
Entity Type:Organization
Organization Name:GONZALES FAMILY, INC
Other - Org Name:ALTERNATIVE HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-425-1538
Mailing Address - Street 1:1118 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4025
Mailing Address - Country:US
Mailing Address - Phone:505-425-1538
Mailing Address - Fax:505-425-7682
Practice Address - Street 1:1118 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4025
Practice Address - Country:US
Practice Address - Phone:505-425-1538
Practice Address - Fax:505-425-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6211251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32-7099OtherMEDICARE LEGACY NUMBER
NM327099Medicare Oscar/Certification