Healthcare Provider Details

I. General information

NPI: 1629285135
Provider Name (Legal Business Name): THI OF NEW MEXICO AT EN SU CASA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-3917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: JUDY RICHARDS
Title or Position: PRESIDENT
Credential:
Phone: 505-522-7000