Individual ProviderKevin Ray Perea05Case Manager/Care CoordinatorOther Service ProvidersPractice Address632 Chama St SE Apt A, Albuquerque, NM 87108-3963(505) 212-7470PECOS EnrollmentBased on the most recent information from CMS, provider Kevin Ray Perea05 does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1659673465Provider TypeIndividualFull NamePerea05, Kevin RayGenderMaleSole ProprietorNoEnumeration Date11/30/2010Last Updated11/30/2010Contact InformationPractice LocationPractice Address632 Chama St SE Apt A, Albuquerque, NM 87108-3963Phone(505) 212-7470FaxUnlisted FaxMailing LocationMailing Address632 Chama St SE Apt A, Albuquerque, NM 87108-3963PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer