Provider Demographics
NPI:1811346273
Name:TERRIER, LLC
Entity type:Organization
Organization Name:TERRIER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-798-0800
Mailing Address - Street 1:11000 SPAIN RD NE
Mailing Address - Street 2:BLDG B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1883
Mailing Address - Country:US
Mailing Address - Phone:505-798-0800
Mailing Address - Fax:
Practice Address - Street 1:11000 SPAIN RD NE
Practice Address - Street 2:BLDG B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1883
Practice Address - Country:US
Practice Address - Phone:505-798-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67683240Medicaid