Healthcare Provider Details

I. General information

NPI: 1316148430
Provider Name (Legal Business Name): IDEAL HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 LA JOYA ST
ESPANOLA NM
87532-2877
US

IV. Provider business mailing address

706 LA JOYA ST
ESPANOLA NM
87532-2877
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-4440
  • Fax:
Mailing address:
  • Phone: 505-747-4440
  • Fax: 505-747-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. REINA CORIZ
Title or Position: VICE-PRESIDENT
Credential:
Phone: 505-747-4440