Provider Demographics
NPI:1255433579
Name:JUSTUS, LLC
Entity type:Organization
Organization Name:JUSTUS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-349-9050
Mailing Address - Street 1:3812 ACADEMY PARKWAY NORTH NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4409
Mailing Address - Country:US
Mailing Address - Phone:505-217-2490
Mailing Address - Fax:505-873-1060
Practice Address - Street 1:3812 ACADEMY PARKWAY NORTH NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4409
Practice Address - Country:US
Practice Address - Phone:505-217-2490
Practice Address - Fax:505-873-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2T3217251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35224266Medicaid
321559Medicare ID - Type Unspecified