Healthcare Provider Details

I. General information

NPI: 1164652426
Provider Name (Legal Business Name): COORDINATED SKILLED CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W BOUTZ RD BUILDING 6
LAS CRUCES NM
88005-3262
US

IV. Provider business mailing address

205 W BOUTZ RD BUILDING 6
LAS CRUCES NM
88005-3262
US

V. Phone/Fax

Practice location:
  • Phone: 505-523-8885
  • Fax: 505-525-3137
Mailing address:
  • Phone: 505-523-8885
  • Fax: 505-525-3137

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: PHILIP DOHERTY
Title or Position: CEO
Credential:
Phone: 575-541-4201