Provider Demographics
NPI:1669285409
Name:INDIGO SUN PALLIATIVE CARE
Entity type:Organization
Organization Name:INDIGO SUN PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-365-0321
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6746
Mailing Address - Country:US
Mailing Address - Phone:505-365-0321
Mailing Address - Fax:505-520-0131
Practice Address - Street 1:4273 MONTGOMERY BLVD NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6746
Practice Address - Country:US
Practice Address - Phone:505-365-0321
Practice Address - Fax:505-520-0131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WILLOW FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty