Healthcare Provider Details

I. General information

NPI: 1730327875
Provider Name (Legal Business Name): FAMILIA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HIGHWAY 478
ANTHONY NM
88021-9332
US

IV. Provider business mailing address

700 HIGHWAY 478
ANTHONY NM
88021-9332
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-3710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number14589516
License Number StateNM

VIII. Authorized Official

Name: MR. JAMES CADENA
Title or Position: OWNER
Credential:
Phone: 480-206-5930