Healthcare Provider Details

I. General information

NPI: 1174319479
Provider Name (Legal Business Name): ENCHANTMENT HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 HENRIETTA DR
GALLUP NM
87301-5441
US

IV. Provider business mailing address

PO BOX 8028
ALBUQUERQUE NM
87198
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-5401
  • Fax:
Mailing address:
  • Phone: 505-879-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAWN CALAVAZA
Title or Position: OWNER
Credential:
Phone: 505-450-5401