Provider Demographics
NPI:1316091671
Name:BEHAVIORAL HOME CARE
Entity type:Organization
Organization Name:BEHAVIORAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MBA
Authorized Official - Phone:505-892-1830
Mailing Address - Street 1:1453 RIO RANCHO DR SE STE C
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1837
Mailing Address - Country:US
Mailing Address - Phone:505-892-1830
Mailing Address - Fax:505-896-1539
Practice Address - Street 1:1453 RIO RANCHO DR SE STE C
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1837
Practice Address - Country:US
Practice Address - Phone:505-892-1830
Practice Address - Fax:505-896-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0600098189251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70884579Medicaid
NMK2335Medicaid