Provider Demographics
NPI:1114740875
Name:AUTHENTIC PERSONAL CARE SERVICES LLC
Entity type:Organization
Organization Name:AUTHENTIC PERSONAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MONTELONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-881-4000
Mailing Address - Street 1:6303 INDIAN SCHOOL RD NE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5317
Mailing Address - Country:US
Mailing Address - Phone:505-881-4000
Mailing Address - Fax:505-881-4100
Practice Address - Street 1:6303 INDIAN SCHOOL RD NE STE 104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5317
Practice Address - Country:US
Practice Address - Phone:505-881-4000
Practice Address - Fax:505-881-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN0008246Medicaid