Provider Demographics
NPI:1831321116
Name:ABANZA PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:ABANZA PERSONAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:ZULMA
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-554-1012
Mailing Address - Street 1:1717 LOUISIANA BLVD NE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7014
Mailing Address - Country:US
Mailing Address - Phone:505-554-1012
Mailing Address - Fax:505-554-3967
Practice Address - Street 1:1717 LOUISANA BLVD NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7014
Practice Address - Country:US
Practice Address - Phone:505-554-1012
Practice Address - Fax:505-554-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-169549-00-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health