Healthcare Provider Details

I. General information

NPI: 1427392059
Provider Name (Legal Business Name): CIMARRON HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356B EAST 9TH STREET
CIMARRON NM
87714-7714
US

IV. Provider business mailing address

PO BOX 363 356B EAST 9TH STREET
CIMARRON NM
87714-0363
US

V. Phone/Fax

Practice location:
  • Phone: 575-376-2000
  • Fax: 575-376-2065
Mailing address:
  • Phone: 575-376-2000
  • Fax: 575-376-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CATHERINE MARIE SEDILLO
Title or Position: OWNER
Credential:
Phone: 575-376-2000