Provider Demographics
NPI:1548633563
Name:CHARTER HEALTHCARE OF ALBUQUERQUE, LLC
Entity type:Organization
Organization Name:CHARTER HEALTHCARE OF ALBUQUERQUE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-644-4964
Mailing Address - Street 1:12126 HWY 14 N STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9406
Mailing Address - Country:US
Mailing Address - Phone:505-286-4219
Mailing Address - Fax:505-286-7735
Practice Address - Street 1:12126 HWY 14 N STE A
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9406
Practice Address - Country:US
Practice Address - Phone:505-286-4219
Practice Address - Fax:505-286-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3547251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based