Healthcare Provider Details

I. General information

NPI: 1154671683
Provider Name (Legal Business Name): EVANGEL HOMECARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 E. MISSOURI AVE BONITA PLAZA #8
LAS CRUCES NM
88011-5075
US

IV. Provider business mailing address

2801 E. MISSOURI AVE BONITA PLAZA #8
LAS CRUCES NM
88011-5075
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9178
  • Fax:
Mailing address:
  • Phone: 575-556-9178
  • 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: MR. NNAEMEKA IBEABUCHI ODUNZE
Title or Position: CEO
Credential:
Phone: 713-540-2760