Healthcare Provider Details

I. General information

NPI: 1134763154
Provider Name (Legal Business Name): THE SCO CLUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MONTERREY RD NE
RIO RANCHO NM
87144-1584
US

IV. Provider business mailing address

1500 MONTERREY RD NE
RIO RANCHO NM
87144-1584
US

V. Phone/Fax

Practice location:
  • Phone: 505-353-6202
  • Fax: 505-214-5701
Mailing address:
  • Phone: 505-353-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRANON BASHTON
Title or Position: OWNER
Credential:
Phone: 505-644-0685