Healthcare Provider Details

I. General information

NPI: 1538985767
Provider Name (Legal Business Name): AMPLIFIED HOME VISITING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 HUTTON AVE
FARMINGTON NM
87402-4562
US

IV. Provider business mailing address

PO BOX 86
CLIFF NM
88028-0086
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-9109
  • Fax: 505-325-9404
Mailing address:
  • Phone: 575-535-2499
  • Fax: 575-535-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DESTRE SHELLEY
Title or Position: CFO
Credential:
Phone: 575-535-2499