Provider Demographics
NPI:1598847113
Name:ALBUQUERQUE PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:ALBUQUERQUE PERSONAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BOBBYJO
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-872-2172
Mailing Address - Street 1:6301 INDIAN SCHOOL RD NE STE 350
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8170
Mailing Address - Country:US
Mailing Address - Phone:505-872-2172
Mailing Address - Fax:505-872-2647
Practice Address - Street 1:6301 INDIAN SCHOOL RD NE STE 350
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8170
Practice Address - Country:US
Practice Address - Phone:505-872-2172
Practice Address - Fax:505-872-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97654710Medicaid