Provider Demographics
NPI:1154494011
Name:BEBE CARE
Entity Type:Organization
Organization Name:BEBE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMUDROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-266-3835
Mailing Address - Street 1:3100 MONTE VISTA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2118
Mailing Address - Country:US
Mailing Address - Phone:505-266-3835
Mailing Address - Fax:505-266-3340
Practice Address - Street 1:3100 MONTE VISTA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2118
Practice Address - Country:US
Practice Address - Phone:505-266-3835
Practice Address - Fax:505-266-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87-73174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51854Medicaid
NM0281OtherBLUE CROSS BLUE SHIELD
NM51854Medicaid