Healthcare Provider Details

I. General information

NPI: 1265035950
Provider Name (Legal Business Name): EL MIRADOR HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOMAS BLVD NE STE 110
ALBUQUERQUE NM
87112-5474
US

IV. Provider business mailing address

10801 LOMAS BLVD NE STE 110
ALBUQUERQUE NM
87112-5474
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-5941
  • Fax: 505-271-0484
Mailing address:
  • Phone: 505-293-5941
  • Fax: 505-271-0484

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: KEN MEYERS
Title or Position: DIRECTOR
Credential:
Phone: 505-293-5941