Healthcare Provider Details

I. General information

NPI: 1659182962
Provider Name (Legal Business Name): NEW MEXICO SUPPORT NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S MESQUITE ST
LAS CRUCES NM
88001-3622
US

IV. Provider business mailing address

735 S MESQUITE ST
LAS CRUCES NM
88001-3622
US

V. Phone/Fax

Practice location:
  • Phone: 616-566-3803
  • Fax:
Mailing address:
  • Phone: 616-566-3803
  • 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: NELSON JUMA KAP-KIRWOK
Title or Position: LPN
Credential:
Phone: 616-566-3803