Healthcare Provider Details

I. General information

NPI: 1992832455
Provider Name (Legal Business Name): NATIVE RESOURCE DEVELOPMENT COMPANY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 DEE ANN AVE
GALLUP NM
87301-5783
US

IV. Provider business mailing address

318 DEE ANN AVE
GALLUP NM
87301-5783
US

V. Phone/Fax

Practice location:
  • Phone: 505-726-0201
  • Fax: 505-726-0202
Mailing address:
  • Phone: 505-726-0201
  • Fax: 505-726-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number777245
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number30550297
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number073338
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number24855731
License Number StateNM

VIII. Authorized Official

Name: PENNY EMERSON
Title or Position: OWNER
Credential:
Phone: 505-867-5372