Provider Demographics
NPI:1891044517
Name:AT HOME GERIATRIC COUNSELING AND CONSULTATION
Entity Type:Organization
Organization Name:AT HOME GERIATRIC COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXROY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-710-4278
Mailing Address - Street 1:25 CAMINO COLLADO
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-9788
Mailing Address - Country:US
Mailing Address - Phone:505-710-4278
Mailing Address - Fax:505-407-4848
Practice Address - Street 1:25 CAMINO COLLADO
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9788
Practice Address - Country:US
Practice Address - Phone:505-710-4278
Practice Address - Fax:505-407-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-069261041C0700X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty