Healthcare Provider Details

I. General information

NPI: 1518184860
Provider Name (Legal Business Name): MORA VALLEY COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE HWY 518
MORA NM
87732
US

IV. Provider business mailing address

PO BOX 209
MORA NM
87732-0209
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number15506
License Number StateNM

VIII. Authorized Official

Name: MS. WANDA RENAY SALAZAR
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 575-387-5069