Provider Demographics
NPI:1104563923
Name:BOSQUE TRAILS HOSPICE LLC
Entity type:Organization
Organization Name:BOSQUE TRAILS HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RN
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-808-2870
Mailing Address - Street 1:303 SAN MATEO BLVD NE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1382
Mailing Address - Country:US
Mailing Address - Phone:505-808-2870
Mailing Address - Fax:505-322-2709
Practice Address - Street 1:303 SAN MATEO BLVD NE STE 104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1382
Practice Address - Country:US
Practice Address - Phone:505-808-2870
Practice Address - Fax:505-322-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based