Healthcare Provider Details

I. General information

NPI: 1164937199
Provider Name (Legal Business Name): ENCHANTED HILLS HOME HEALTHCARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 MONTGOMERY BLVD. NE BUILDING K STE. 130
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

7555 ENCHANTED HILLS BLVD NE STE 200
RIO RANCHO NM
87144-8625
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-0621
  • Fax:
Mailing address:
  • Phone: 505-867-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3202B1
License Number StateNM

VIII. Authorized Official

Name: MELISSA JOHNS
Title or Position: OWNER
Credential: RN
Phone: 505-867-0621