Provider Demographics
NPI:1467237958
Name:LTC HOME CARE, LLC
Entity Type:Organization
Organization Name:LTC HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE
Authorized Official - Phone:505-234-4272
Mailing Address - Street 1:605 FOX LN SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3546
Mailing Address - Country:US
Mailing Address - Phone:505-234-4272
Mailing Address - Fax:
Practice Address - Street 1:605 FOX LN SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3546
Practice Address - Country:US
Practice Address - Phone:505-234-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health