Healthcare Provider Details

I. General information

NPI: 1063160364
Provider Name (Legal Business Name): ONE CARE NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W COAL AVE
GALLUP NM
87301-6643
US

IV. Provider business mailing address

907 W COAL AVE
GALLUP NM
87301-6643
US

V. Phone/Fax

Practice location:
  • Phone: 505-726-4155
  • Fax:
Mailing address:
  • Phone: 505-726-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHANNAD RASHID
Title or Position: MANAGER/OWNER
Credential: PHARMD
Phone: 505-726-4155