Provider Demographics
NPI:1265974331
Name:ALBUQUERQUE
Entity type:Organization
Organization Name:ALBUQUERQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HONSOWETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-803-7597
Mailing Address - Street 1:4801 LANG AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4475
Mailing Address - Country:US
Mailing Address - Phone:505-702-8304
Mailing Address - Fax:
Practice Address - Street 1:4801 LANG AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4475
Practice Address - Country:US
Practice Address - Phone:505-702-8304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care