Healthcare Provider Details

I. General information

NPI: 1528923190
Provider Name (Legal Business Name): EXCELACARE HOSPICE OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N MAIN ST STE 19A
CLOVIS NM
88101-3575
US

IV. Provider business mailing address

101 W RENNER RD STE 420
RICHARDSON TX
75082-2022
US

V. Phone/Fax

Practice location:
  • Phone: 575-763-9728
  • Fax: 575-762-2166
Mailing address:
  • Phone: 575-763-9728
  • Fax: 575-762-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONNIE MABERRY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 972-468-8070