Healthcare Provider Details

I. General information

NPI: 1619052107
Provider Name (Legal Business Name): DIRECT HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 SULTAN ST
LAS VEGAS NM
87701-8902
US

IV. Provider business mailing address

5309 SULTAN ST
LAS VEGAS NM
87701-8902
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-7471
  • Fax: 505-425-6477
Mailing address:
  • Phone: 505-425-7471
  • Fax: 505-454-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DANNY DOWNS
Title or Position: OWNER
Credential:
Phone: 505-425-7471