Healthcare Provider Details

I. General information

NPI: 1538647615
Provider Name (Legal Business Name): AMOR POR FAMILIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 STATE HIGHWAY 121
CHACON NM
87713
US

IV. Provider business mailing address

PO BOX 255
HOLMAN NM
87723-0255
US

V. Phone/Fax

Practice location:
  • Phone: 505-718-2368
  • Fax:
Mailing address:
  • Phone: 505-718-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DELILAH MEDINA
Title or Position: MEMBER
Credential: MSW
Phone: 505-718-2368