Healthcare Provider Details

I. General information

NPI: 1609293331
Provider Name (Legal Business Name): QUALITY MINERS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N FIRST ST
GRANTS NM
87020-2544
US

IV. Provider business mailing address

PO BOX 1718
GRANTS NM
87020-1718
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-9861
  • Fax: 888-972-4314
Mailing address:
  • Phone: 505-285-9861
  • Fax: 888-972-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3461
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RHONDA G MOORE
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 505-285-9861