Healthcare Provider Details

I. General information

NPI: 1023657301
Provider Name (Legal Business Name): LOVING HANDS SUPPORTIVE LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 CAMINO DE LA TIERRA
CORRALES NM
87048-6909
US

IV. Provider business mailing address

PO BOX 45623
RIO RANCHO NM
87174-5623
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-5664
  • Fax:
Mailing address:
  • Phone: 505-803-5664
  • 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: HUAN HILL
Title or Position: DIRECTOR
Credential:
Phone: 505-803-5664