Provider Demographics
NPI:1245995315
Name:BACA COMMUNITY HEALTH
Entity type:Organization
Organization Name:BACA COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEITHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-491-8173
Mailing Address - Street 1:2921 CARLISLE BLVD NE STE 119
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2864
Mailing Address - Country:US
Mailing Address - Phone:505-539-5290
Mailing Address - Fax:505-212-6368
Practice Address - Street 1:2921 CARLISLE BLVD NE STE 125
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2865
Practice Address - Country:US
Practice Address - Phone:505-573-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty