Provider Demographics
NPI:1174861942
Name:ALBUQUERQUE COMPLETE SENIOR CARE LLC
Entity Type:Organization
Organization Name:ALBUQUERQUE COMPLETE SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-217-2490
Mailing Address - Street 1:3812 ACADEMY PARKWAY NORTH NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4409
Mailing Address - Country:US
Mailing Address - Phone:505-938-7431
Mailing Address - Fax:855-427-2693
Practice Address - Street 1:3812 ACADEMY PARKWAY NORTH NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4409
Practice Address - Country:US
Practice Address - Phone:505-938-7431
Practice Address - Fax:855-427-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86-083207R00000X
NM89-872084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty