Healthcare Provider Details

I. General information

NPI: 1245336569
Provider Name (Legal Business Name): R-WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JOHNNY ROYBAL INDUSTRIAL PARK RD SUITE A
ESPANOLA NM
87532-2629
US

IV. Provider business mailing address

1101 JOHNNY ROYBAL INDUSTRIAL PARK RD SUITE A
ESPANOLA NM
87532-2629
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-0060
  • Fax: 505-753-0059
Mailing address:
  • Phone: 505-753-0060
  • Fax: 505-753-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLEE J CORDOVA
Title or Position: DIRECTOR OWNER
Credential:
Phone: 505-753-0060