Healthcare Provider Details

I. General information

NPI: 1700864204
Provider Name (Legal Business Name): MORA VALLEY COMMUNITY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE HIGHWAY 518 MILEMARKER 26
MORA NM
87732-0209
US

IV. Provider business mailing address

PO BOX 209 STATE HWY 518 MM 26
MORA NM
87732-0209
US

V. Phone/Fax

Practice location:
  • Phone: 575-387-6078
  • Fax: 575-387-2034
Mailing address:
  • Phone: 575-387-5069
  • Fax: 575-387-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6008
License Number StateNM

VIII. Authorized Official

Name: MRS. LORRAINE FRENCH
Title or Position: OFFICE MANAGER CARDID DE SAN ANTONI
Credential:
Phone: 575-387-6078