Healthcare Provider Details

I. General information

NPI: 1619011889
Provider Name (Legal Business Name): MOUNTAIN SHADOWS HOME CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N TELSHOR BLVD STE. B
LAS CRUCES NM
88011-8251
US

IV. Provider business mailing address

800 N TELSHOR BLVD STE. B
LAS CRUCES NM
88011-8251
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-1366
  • Fax: 505-521-4772
Mailing address:
  • Phone: 505-521-1366
  • Fax: 505-521-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6050
License Number StateNM

VIII. Authorized Official

Name: LIZA E. BARBEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-541-3962