Provider Demographics
NPI:1609606169
Name:21ST CENTURY QUALITY HOME CARE NEW MEXICO, LLC
Entity type:Organization
Organization Name:21ST CENTURY QUALITY HOME CARE NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIEASHA
Authorized Official - Middle Name:TASHAY
Authorized Official - Last Name:JAMES WADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-308-0776
Mailing Address - Street 1:503 ROSEN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2752
Mailing Address - Country:US
Mailing Address - Phone:832-367-9087
Mailing Address - Fax:
Practice Address - Street 1:1209 MOUNTAIN ROAD PL NE STE N
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7845
Practice Address - Country:US
Practice Address - Phone:832-367-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care