Provider Demographics
NPI:1285137034
Name:ALBUQUERQUE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ALBUQUERQUE HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-304-2473
Mailing Address - Street 1:7924 WILLIAM MOYERS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2739
Mailing Address - Country:US
Mailing Address - Phone:505-304-2473
Mailing Address - Fax:
Practice Address - Street 1:8200 MOUNTAIN RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7843
Practice Address - Country:US
Practice Address - Phone:505-304-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74728024Medicaid