Healthcare Provider Details

I. General information

NPI: 1841542362
Provider Name (Legal Business Name): NEW HOPE HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W MALONEY AVE STE C
GALLUP NM
87301-5487
US

IV. Provider business mailing address

1020 W MALONEY AVE STE C
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-7007
  • Fax:
Mailing address:
  • Phone: 505-722-7007
  • Fax:

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: JIMMY P OTERO
Title or Position: OWNER
Credential:
Phone: 505-722-7007