Provider Demographics
NPI: | 1548545288 |
---|---|
Name: | WOODS CROSS INVESTMENTS LLC |
Entity type: | Organization |
Organization Name: | WOODS CROSS INVESTMENTS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | PRIYA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DIAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 714-981-2995 |
Mailing Address - Street 1: | 2401 WELLESLEY DR NE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87107-1811 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-883-8888 |
Mailing Address - Fax: | 505-883-2830 |
Practice Address - Street 1: | 2401 WELLESLEY DRIVE NE |
Practice Address - Street 2: | |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87107 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-883-8888 |
Practice Address - Fax: | 505-883-2830 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-10-13 |
Last Update Date: | 2011-10-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | FA0060766 | 171W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171W00000X | Other Service Providers | Contractor | Group - Single Specialty |