Healthcare Provider Details

I. General information

NPI: 1083982615
Provider Name (Legal Business Name): EMERGENT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 E SANTA FE AVE SUITE 224
GRANTS NM
87020-4006
US

IV. Provider business mailing address

1604 E SANTA FE AVE SUITE 224
GRANTS NM
87020-4006
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-0757
  • Fax: 505-216-2642
Mailing address:
  • Phone: 505-285-0757
  • Fax: 505-216-2642

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: KAREN WALKER
Title or Position: BUSINESS DEVELOPMENT DIRECTOR
Credential: LPN, ASN
Phone: 505-285-0757