Healthcare Provider Details

I. General information

NPI: 1952085136
Provider Name (Legal Business Name): MY PEOPLES HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N AUBURN AVE
FARMINGTON NM
87401-8412
US

IV. Provider business mailing address

216 N AUBURN AVE
FARMINGTON NM
87401-8412
US

V. Phone/Fax

Practice location:
  • Phone: 505-320-5230
  • Fax: 505-258-4356
Mailing address:
  • Phone: 505-320-5230
  • Fax: 505-258-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JAROLEEN LYNNEA SMITH
Title or Position: OWNER/ADMINISTRATOR
Credential: MHA
Phone: 505-320-5230