Organization
LIFE SUPPORT HOME HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CANDICE M SPARKS (PRESIDENT)
(505) 821-1107
Entity
Organization
Contact information
Practice address
12901 SAND CHERRY PL NE, ALBUQUERQUE, NM 87111
(505) 856-1321
(505) 797-1328
Mailing address
12901 SAND CHERRY PL NE, ALBUQUERQUE, NM 87111
(505) 856-1321
(505) 797-1328
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
6775A1
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D4145
MEDICAID WAIVER
NM
Enumeration date
01/14/2008
Last updated
01/14/2008
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