Basic Information
| Provider Information | |||||||||
| NPI: | 1346282845 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMERICARE HEALTH SERVICES CORPORATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | AMERICARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SUN AVE NE | ||||||||
| Address2: | COMPLIANCE DEPARTMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054685604 | ||||||||
| FaxNumber: | 5054684681 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 SUN AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054684678 | ||||||||
| FaxNumber: | 5054688013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NYLAND | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT-DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5058213355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | 1477 | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BN1400X | 1477 | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 332B00000X | 1477 | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 4581494 | 05 | TN | MEDICAID | 804002800 | 05 | MD | MEDICAID | 806032400 | 05 | ID | MEDICAID | G4622 | 05 | NM | MEDICAID | 9107282 | 05 | VA | MEDICAID | 011269001 | 05 | TX | MEDICAID | 625357009 | 05 | MO | MEDICAID | 000515699A | 05 | GA | MEDICAID | 561101 | 05 | AZ | MEDICAID | 48755508 | 05 | CO | MEDICAID | 90003112 | 05 | KY | MEDICAID | 009105980 | 05 | AL | MEDICAID | 1188573 | 05 | LA | MEDICAID | 200251170A | 05 | IN | MEDICAID | 30761325 | 05 | NH | MEDICAID | 2229565 | 05 | OH | MEDICAID | 7702040 | 05 | NC | MEDICAID |