Provider Demographics
NPI:1366277063
Name:360CAREXLLC
Entity type:Organization
Organization Name:360CAREXLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NP
Authorized Official - Prefix:
Authorized Official - First Name:BETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UBOCHI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:920-850-8549
Mailing Address - Street 1:11000 CANDELARIA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1751
Mailing Address - Country:US
Mailing Address - Phone:505-527-0475
Mailing Address - Fax:
Practice Address - Street 1:11000 CANDELARIA RD NE STE 109E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1700
Practice Address - Country:US
Practice Address - Phone:505-527-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty