Healthcare Provider Details

I. General information

NPI: 1780825372
Provider Name (Legal Business Name): COMPLETE REHAB ADULT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W BLAND
ROSWELL NM
88203
US

IV. Provider business mailing address

109 W BLAND ST
ROSWELL NM
88203
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-2525
  • Fax:
Mailing address:
  • Phone: 575-625-2525
  • Fax: 575-627-5934

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: MIKE HURST
Title or Position: OWNER
Credential:
Phone: 575-625-2525