Healthcare Provider Details

I. General information

NPI: 1679651319
Provider Name (Legal Business Name): CLOVIS HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 W 21ST ST
CLOVIS NM
88101-4026
US

IV. Provider business mailing address

1944 W 21ST ST
CLOVIS NM
88101-4026
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-2243
  • Fax: 575-762-6452
Mailing address:
  • Phone: 575-769-2243
  • Fax: 575-762-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6398
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number6398
License Number StateNM

VIII. Authorized Official

Name: MRS. AMY MICHELLE CORBIN
Title or Position: DIRECTOR
Credential:
Phone: 575-769-2243