Healthcare Provider Details

I. General information

NPI: 1467455766
Provider Name (Legal Business Name): CLAYTON HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON ST
CLAYTON NM
88415-3304
US

IV. Provider business mailing address

PO BOX 489
CLAYTON NM
88415-0489
US

V. Phone/Fax

Practice location:
  • Phone: 575-374-2585
  • Fax: 575-374-8146
Mailing address:
  • Phone: 575-374-2585
  • Fax: 575-374-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6604
License Number StateNM

VIII. Authorized Official

Name: TAMMIE CHAVEZ
Title or Position: CEO
Credential:
Phone: 575-374-2585