Provider Demographics
NPI:1588289334
Name:SOLANA CARE, LC
Entity type:Organization
Organization Name:SOLANA CARE, LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENUNURI-CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-515-6301
Mailing Address - Street 1:4453 WALDEN LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4290
Mailing Address - Country:US
Mailing Address - Phone:505-515-6301
Mailing Address - Fax:
Practice Address - Street 1:4101 MORRIS ST NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3605
Practice Address - Country:US
Practice Address - Phone:505-515-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities