Provider Demographics
NPI:1467120139
Name:NATIONAL NUCLEAR ENERGY HEALTHCARE LLC
Entity Type:Organization
Organization Name:NATIONAL NUCLEAR ENERGY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-402-4067
Mailing Address - Street 1:2012 SAN JUAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2220
Mailing Address - Country:US
Mailing Address - Phone:505-402-4067
Mailing Address - Fax:505-436-2294
Practice Address - Street 1:9480 S EASTERN AVE STE 272
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8000
Practice Address - Country:US
Practice Address - Phone:505-402-4067
Practice Address - Fax:505-436-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health