Healthcare Provider Details

I. General information

NPI: 1134175383
Provider Name (Legal Business Name): RUIDOSO HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 GAVILAN CANYON RD
RUIDOSO NM
88345-6080
US

IV. Provider business mailing address

PO BOX 2019
RUIDOSO NM
88355-2019
US

V. Phone/Fax

Practice location:
  • Phone: 575-258-0028
  • Fax: 575-258-2648
Mailing address:
  • Phone: 575-258-0028
  • Fax: 575-258-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number3096
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3024
License Number StateNM

VIII. Authorized Official

Name: MRS. JENNIFER ANN CHADWICK
Title or Position: ADMINISTRATOR/OWNER
Credential: RN
Phone: 575-258-0028