Provider Demographics
NPI:1952571804
Name:ENCHANTED CARE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ENCHANTED CARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-842-5825
Mailing Address - Street 1:PO BOX 26236
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6236
Mailing Address - Country:US
Mailing Address - Phone:505-842-5825
Mailing Address - Fax:505-842-5837
Practice Address - Street 1:202 CENTRAL AVE SE
Practice Address - Street 2:SUITE 103
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3460
Practice Address - Country:US
Practice Address - Phone:505-842-5825
Practice Address - Fax:505-842-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18820573Medicaid