Provider Demographics
NPI:1114307071
Name:OWENS ADMINISTRATIVE & HEALTHCARE SUPPORT SERVICES LLC SABRINA B OWENS
Entity Type:Organization
Organization Name:OWENS ADMINISTRATIVE & HEALTHCARE SUPPORT SERVICES LLC SABRINA B OWENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-480-9436
Mailing Address - Street 1:2503 METZGAR RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6335
Mailing Address - Country:US
Mailing Address - Phone:505-480-9436
Mailing Address - Fax:
Practice Address - Street 1:4300 BLAKE RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5179
Practice Address - Country:US
Practice Address - Phone:505-243-1118
Practice Address - Fax:505-903-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81031041Medicaid