Provider Demographics
NPI:1386014769
Name:NM 01 PALLIATIVE CARE SERVICES PLLC
Entity Type:Organization
Organization Name:NM 01 PALLIATIVE CARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-842-5460
Mailing Address - Street 1:3544 E 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6911
Mailing Address - Country:US
Mailing Address - Phone:208-524-0685
Mailing Address - Fax:208-524-0686
Practice Address - Street 1:4801 LANG AVE NE
Practice Address - Street 2:SUITE 200A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4474
Practice Address - Country:US
Practice Address - Phone:505-842-5460
Practice Address - Fax:505-842-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care