Healthcare Provider Details

I. General information

NPI: 1508981044
Provider Name (Legal Business Name): SOUTHWESTERN PRIVATE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N AUBURN AVE STE B
FARMINGTON NM
87401-5816
US

IV. Provider business mailing address

408 N AUBURN AVE STE B
FARMINGTON NM
87401-5816
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-6024
  • Fax: 505-327-6923
Mailing address:
  • Phone: 505-326-6024
  • Fax: 505-327-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6547
License Number StateNM

VIII. Authorized Official

Name: IVY SNIDER
Title or Position: VICE PRESIDENT
Credential: RN
Phone: 405-359-2074