Healthcare Provider Details

I. General information

NPI: 1336006295
Provider Name (Legal Business Name): RICHARD SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 ROSEMARY RD
LAS CRUCES NM
88012-0861
US

IV. Provider business mailing address

6222 ROSEMARY RD
LAS CRUCES NM
88012-0861
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-0456
  • Fax:
Mailing address:
  • Phone: 575-323-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number39-4724398
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: