Healthcare Provider Details

I. General information

NPI: 1003458563
Provider Name (Legal Business Name): OAK TREE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LONDON CT
ROSWELL NM
88201-0410
US

IV. Provider business mailing address

5 LONDON CT
ROSWELL NM
88201-0410
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-0232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICAH AARON-ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 575-520-0232