Healthcare Provider Details

I. General information

NPI: 1548035041
Provider Name (Legal Business Name): COUNTY OF LUNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S SLATE ST
DEMING NM
88030-6200
US

IV. Provider business mailing address

1510 S SLATE ST
DEMING NM
88030-6200
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-9254
  • Fax:
Mailing address:
  • Phone: 575-546-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRIS BRICE
Title or Position: COUNTY MANAGER
Credential:
Phone: 575-546-0494