Healthcare Provider Details

I. General information

NPI: 1073986758
Provider Name (Legal Business Name): 4 CORNERS HHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E SANTA FE AVE
GRANTS NM
87020-2499
US

IV. Provider business mailing address

301 S MAIN ST
BLANDING UT
84511-3831
US

V. Phone/Fax

Practice location:
  • Phone: 505-716-3421
  • Fax:
Mailing address:
  • Phone: 505-716-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDI R MCALEXANDER
Title or Position: MANAGER
Credential:
Phone: 505-716-3421