Provider Demographics
NPI:1629659776
Name:TRUSTED ALLY HOME CARE - NEW MEXICO LLC
Entity type:Organization
Organization Name:TRUSTED ALLY HOME CARE - NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:720-442-8386
Mailing Address - Street 1:8101 E PRENTICE AVE STE 775
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2934
Mailing Address - Country:US
Mailing Address - Phone:720-442-8386
Mailing Address - Fax:888-692-9332
Practice Address - Street 1:8101 E PRENTICE AVE STE 775
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2934
Practice Address - Country:US
Practice Address - Phone:720-442-8386
Practice Address - Fax:888-692-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TBDOtherDEPARTMENT OF LABOR DEEOIC