Provider Demographics
NPI:1780067876
Name:EASTERN HILLS HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:EASTERN HILLS HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-401-1188
Mailing Address - Street 1:5800 MCLEOD RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2454
Mailing Address - Country:US
Mailing Address - Phone:505-401-1188
Mailing Address - Fax:505-884-4995
Practice Address - Street 1:5800 MCLEOD RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2454
Practice Address - Country:US
Practice Address - Phone:505-401-1188
Practice Address - Fax:505-884-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1045261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service