Healthcare Provider Details

I. General information

NPI: 1225173230
Provider Name (Legal Business Name): LANDSUN HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 WESTRIDGE RD
CARLSBAD NM
88220-3507
US

IV. Provider business mailing address

1815 WESTRIDGE RD
CARLSBAD NM
88220-3507
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-5830
  • Fax: 505-234-5850
Mailing address:
  • Phone: 505-234-5830
  • Fax: 505-234-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6591
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number3108
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5065
License Number StateNM

VIII. Authorized Official

Name: MRS. MARY CHRISTOPHERSON
Title or Position: ADMINISTRATOR
Credential: RN,BSN
Phone: 505-234-5830