Healthcare Provider Details

I. General information

NPI: 1700610714
Provider Name (Legal Business Name): TOWN OF GRANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W HIGH ST
GRANTS NM
87020-3601
US

IV. Provider business mailing address

620 W HIGH ST
GRANTS NM
87020-3601
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-7927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MAES
Title or Position: FIRE CHIEF
Credential:
Phone: 505-287-7927