Healthcare Provider Details

I. General information

NPI: 1962400663
Provider Name (Legal Business Name): LOS ALAMOS VISITING NURSE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CENTRAL PARK SQ
LOS ALAMOS NM
87544-4020
US

IV. Provider business mailing address

109 CENTRAL PARK SQ
LOS ALAMOS NM
87544-4020
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-2525
  • Fax: 505-662-7390
Mailing address:
  • Phone: 505-662-2525
  • Fax: 505-662-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6036
License Number StateNM

VIII. Authorized Official

Name: WENDI WOLFE
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 505-662-2525