Healthcare Provider Details

I. General information

NPI: 1720084999
Provider Name (Legal Business Name): REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 REDROCK DRIVE
GALLUP NM
87301-5683
US

IV. Provider business mailing address

1901 REDROCK DRIVE
GALLUP NM
87301-5683
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-7000
  • Fax:
Mailing address:
  • Phone: 505-863-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: WAYNE GILLIS
Title or Position: CEO
Credential:
Phone: 505-863-7004