Healthcare Provider Details

I. General information

NPI: 1003044629
Provider Name (Legal Business Name): SPECIAL CARE AT HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WEST MALONEY SUITE B
GALLUP NM
87301
US

IV. Provider business mailing address

PO BOX 4554
YATAHEY NM
87375
US

V. Phone/Fax

Practice location:
  • Phone: 505-726-2890
  • Fax: 505-722-8941
Mailing address:
  • Phone: 505-726-2890
  • Fax: 505-722-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE BENALLY
Title or Position: BOARD PRESIDENT
Credential:
Phone: 505-726-2890