MEDICARE: COORDINATED SKILLED CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1164652426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COORDINATED SKILLED CARE, INC.

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BUILDING 6
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3262
Country	:	US
Telephone Number	:	505-523-8885
Fax Number	:	505-525-3137

Provider Business Practice Location Address
First Line	:	205 W BOUTZ RD
Second Line	:	BUILDING 6
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3262
Country	:	US
Telephone Number	:	505-523-8885
Fax Number	:	505-525-3137

Authorized Official
Title or Position	:	CEO
Name	:	PHILIP DOHERTY
Credential	:
Telephone Number	:	575-541-4201

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2009

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