Healthcare Provider Details

I. General information

NPI: 1790393726
Provider Name (Legal Business Name): TCTT HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD STE Q101
LAS CRUCES NM
88011-4681
US

IV. Provider business mailing address

130 CRESTED PEAK CT
SANTA TERESA NM
88008-9423
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-4400
  • Fax: 575-521-4404
Mailing address:
  • Phone: 575-521-4400
  • Fax: 575-521-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: MS. TONIA C CROWLEY
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 575-915-4393