Healthcare Provider Details

I. General information

NPI: 1437866167
Provider Name (Legal Business Name): DEMING LUNA COUNTY COMMISSION ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S GRANITE ST
DEMING NM
88030-4566
US

IV. Provider business mailing address

800 S GRANITE ST
DEMING NM
88030-4566
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-8823
  • Fax: 575-546-4076
Mailing address:
  • Phone: 575-546-8823
  • Fax: 575-546-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE ANN BOLTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-546-8823