Provider Demographics
NPI:1811014657
Name:PROFESSIONAL CASE COORDINATION AND CONSULTATION INC
Entity Type:Organization
Organization Name:PROFESSIONAL CASE COORDINATION AND CONSULTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-715-3708
Mailing Address - Street 1:PO BOX 67216
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-7216
Mailing Address - Country:US
Mailing Address - Phone:505-715-3708
Mailing Address - Fax:505-508-1214
Practice Address - Street 1:5773 TOSCA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3857
Practice Address - Country:US
Practice Address - Phone:505-715-3708
Practice Address - Fax:505-508-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health