Provider Demographics
NPI:1629110846
Name:SUPPORTING HANDS, LLC
Entity Type:Organization
Organization Name:SUPPORTING HANDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:505-203-9874
Mailing Address - Street 1:7605 RAYMOND DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5428
Mailing Address - Country:US
Mailing Address - Phone:505-203-9874
Mailing Address - Fax:505-821-1850
Practice Address - Street 1:7605 RAYMOND DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5428
Practice Address - Country:US
Practice Address - Phone:505-203-9874
Practice Address - Fax:505-821-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75129027320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75129027Medicaid