Basic Information
| Provider Information | |||||||||
| NPI: | 1639206717 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THI OF NEW MEXICO HOSPICE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPICE COMPASSUS - ALBUQUERQUE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154255407 | ||||||||
| FaxNumber: | 6153734457 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 UPTOWN BLVD. NE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053320847 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6154255418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 1T3242 | NM | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 18232574 | 05 | NM | MEDICAID |