Healthcare Provider Details

I. General information

NPI: 1366194623
Provider Name (Legal Business Name): ORGAN MOUNTAINS HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5668 CAMINO ESCONDIDA
LAS CRUCES NM
88011-2605
US

IV. Provider business mailing address

PO BOX 1788
MESILLA PARK NM
88047-1788
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-2988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SELENE MARIE LA MARCA
Title or Position: MEMBER
Credential: DNP
Phone: 575-644-2988