Healthcare Provider Details

I. General information

NPI: 1174868756
Provider Name (Legal Business Name): HOME HEALTH OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 CANDELARIA ROAD NE SUITE K
ALBUQUERQUE NM
87107-1952
US

IV. Provider business mailing address

125 BANK STREET SUITE 200
MISSOULA MT
59802-4412
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-8182
  • Fax: 505-830-9444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEIDI DAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 406-532-1900