Healthcare Provider Details

I. General information

NPI: 1770266108
Provider Name (Legal Business Name): FIRSTLINE HEALTHCARE AND GENERAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PLATEAU CIR
GALLUP NM
87301-4836
US

IV. Provider business mailing address

905 PLATEAU CIR
GALLUP NM
87301-4836
US

V. Phone/Fax

Practice location:
  • Phone: 505-409-7614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. OMOSEHIN MOYEBI
Title or Position: CEO
Credential: PHD
Phone: 505-409-7614