Healthcare Provider Details

I. General information

NPI: 1164572533
Provider Name (Legal Business Name): REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 REDROCK DR
GALLUP NM
87301-5683
US

IV. Provider business mailing address

1901 REDROCK DR
GALLUP NM
87301-5683
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-7000
  • Fax: 505-726-6708
Mailing address:
  • Phone: 505-863-7000
  • Fax: 505-726-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6267
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: WAYNE GILLIS
Title or Position: CEO
Credential:
Phone: 505-863-7001