Basic Information
| Provider Information | |||||||||
| NPI: | 1821117953 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOGARES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6485 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871976485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053458471 | ||||||||
| FaxNumber: | 5053425414 | ||||||||
| Practice Location | |||||||||
| Address1: | 1218 GRIEGOS RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871073752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053458471 | ||||||||
| FaxNumber: | 5053425414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | ARCHER | ||||||||
| AuthorizedOfficialFirstName: | NANCY JO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5053458471 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | VNM30495MD | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | VNM30330NO | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | NM600253 | 01 | NM | HEALTH PLAN PIN | OTHER | VNM30308NO | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | VNM30305NO | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | VNM30306NO | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | VNM3039NO | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | VNM30495NO | 01 | NM | HEALTH PLAN PROVIDER # | OTHER | VNM30495NI | 01 | NM | HEALTH PLAN PROVIDER # | OTHER |