Provider Demographics
NPI:1063799179
Name:ABANZA PESONAL CARE SERVICES II LLC
Entity type:Organization
Organization Name:ABANZA PESONAL CARE SERVICES II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:ZULMA
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-554-1012
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-1297
Mailing Address - Country:US
Mailing Address - Phone:575-882-1899
Mailing Address - Fax:575-882-1949
Practice Address - Street 1:950 ANTHONY DR
Practice Address - Street 2:SUITE # 3
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-1297
Practice Address - Country:US
Practice Address - Phone:575-882-1899
Practice Address - Fax:575-882-1949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABANZA PERSONAL CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM88575063251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health