Provider Demographics
NPI:1659421360
Name:DAVIS PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:DAVIS PERSONAL CARE SERVICES LLC
Other - Org Name:DAVIS PERSONAL CARE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-256-9587
Mailing Address - Street 1:1020 SAN PEDRO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6722
Mailing Address - Country:US
Mailing Address - Phone:505-256-9587
Mailing Address - Fax:505-266-2484
Practice Address - Street 1:1020 SAN PEDRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6722
Practice Address - Country:US
Practice Address - Phone:505-256-9587
Practice Address - Fax:505-266-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75077311Medicaid