Healthcare Provider Details

I. General information

NPI: 1780025007
Provider Name (Legal Business Name): SOUTHWEST HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E SANTA FE AVE
GRANTS NM
87020-2436
US

IV. Provider business mailing address

920 E SANTA FE AVE
GRANTS NM
87020-2436
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-7472
  • Fax: 505-287-7473
Mailing address:
  • Phone: 505-287-7472
  • Fax: 505-287-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03-191409-00-8
License Number StateNM

VIII. Authorized Official

Name: MRS. LAKEITHA C BURTON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 505-539-5290