Healthcare Provider Details

I. General information

NPI: 1053221416
Provider Name (Legal Business Name): LOVING PATH DIRECT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 VIAJERO AVE
MCINTOSH NM
87032-7066
US

IV. Provider business mailing address

PO BOX 523
MCINTOSH NM
87032-0523
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-6874
  • Fax:
Mailing address:
  • Phone: 505-717-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN GRITCHEN II
Title or Position: HR
Credential: NONE
Phone: 505-717-6874