Healthcare Provider Details

I. General information

NPI: 1558803833
Provider Name (Legal Business Name): ENTRUST HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N 1ST ST
GRANTS NM
87020
US

IV. Provider business mailing address

617 N 1ST ST
GRANTS NM
87020-2703
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-9958
  • Fax:
Mailing address:
  • Phone: 505-285-9958
  • 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: REBECCA QUINTANA
Title or Position: VICE PRESIDENT
Credential:
Phone: 505-285-9958