Healthcare Provider Details

I. General information

NPI: 1790805117
Provider Name (Legal Business Name): 800-HOMECARE, TRUSTED CARE AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 SOUTH MAIN STREET BLDG. D, SUITE H
LAS CRUCES NM
88005-2909
US

IV. Provider business mailing address

3721 RUTLEDGE ROAD, NE
ALBUQUERQUE NM
87109-5566
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-2323
  • Fax: 575-522-2322
Mailing address:
  • Phone: 505-796-3200
  • Fax: 505-796-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03-091034-00-0
License Number StateNM

VIII. Authorized Official

Name: MR. SHAWN W. RICKETTS
Title or Position: CFO
Credential:
Phone: 505-796-3200