Healthcare Provider Details

I. General information

NPI: 1194327734
Provider Name (Legal Business Name): SERVICIOS Y MAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S RIVERSIDE DR STE G
ESPANOLA NM
87532-3394
US

IV. Provider business mailing address

424 S RIVERSIDE DR STE G
ESPANOLA NM
87532-3394
US

V. Phone/Fax

Practice location:
  • Phone: 505-595-4848
  • Fax: 888-504-0115
Mailing address:
  • Phone: 505-753-3512
  • Fax: 888-504-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMINA OSORIA
Title or Position: CCSS/CCHW
Credential: CCHW
Phone: 505-753-3512