Healthcare Provider Details

I. General information

NPI: 1043615925
Provider Name (Legal Business Name): SHILOH HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 LARGO ST STE A
FARMINGTON NM
87402-8629
US

IV. Provider business mailing address

4301 LARGO ST STE A
FARMINGTON NM
87402-8629
US

V. Phone/Fax

Practice location:
  • Phone: 505-436-3350
  • Fax: 505-213-1523
Mailing address:
  • Phone: 505-436-3350
  • Fax: 505-213-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR52598
License Number StateNM

VIII. Authorized Official

Name: MRS. SARA L GONZALES
Title or Position: OWNER, ADMINISTRATOR, R.N.
Credential: R.N.,ADMINISTRATOR,
Phone: 505-436-3350