Provider Demographics
NPI:1326612300
Name:ACACIA FAMILY CARE LLC
Entity Type:Organization
Organization Name:ACACIA FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-205-0754
Mailing Address - Street 1:PO BOX 4569
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-4569
Mailing Address - Country:US
Mailing Address - Phone:575-205-0754
Mailing Address - Fax:575-205-0758
Practice Address - Street 1:1717 W 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-2027
Practice Address - Country:US
Practice Address - Phone:575-205-0754
Practice Address - Fax:575-205-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty