Provider Demographics
NPI:1972934743
Name:ROADRUNNER HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ROADRUNNER HOME HEALTH, LLC
Other - Org Name:ROADRUNNER HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:505-321-7295
Mailing Address - Street 1:PO BOX 2046
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2046
Mailing Address - Country:US
Mailing Address - Phone:505-321-7295
Mailing Address - Fax:
Practice Address - Street 1:2469 CORRALES RD
Practice Address - Street 2:SUITE A BUILDING A
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048
Practice Address - Country:US
Practice Address - Phone:505-737-8213
Practice Address - Fax:505-508-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1T7084OtherSTATE LICENSE