Individual ProviderJerika SelphCase Manager/Care CoordinatorOther Service ProvidersPractice Address5601 Domingo Rd NE, Albuquerque, NM 87108-1610(505) 268-5295PECOS EnrollmentBased on the most recent information from CMS, provider Jerika Selph 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 ID1851798649Provider TypeIndividualFull NameSelph, JerikaGenderFemaleSole ProprietorYesEnumeration Date11/24/2014Last Updated11/24/2014Contact InformationPractice LocationPractice Address5601 Domingo Rd NE, Albuquerque, NM 87108-1610Phone(505) 268-5295Fax(505) 268-9967Mailing LocationMailing Address5601 Domingo Rd NE, Albuquerque, NM 87108Phone(505) 268-5295Fax(505) 268-9967Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDB9311DescriptionMedicaidIssuerUnlistedNew Mexico