Healthcare Provider Details

I. General information

NPI: 1265879712
Provider Name (Legal Business Name): ENCHANTED CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 HARKLE RD SUITE B
SANTA FE NM
87505-4784
US

IV. Provider business mailing address

223 N GUADALUPE ST SUITE 162
SANTA FE NM
87501-1868
US

V. Phone/Fax

Practice location:
  • Phone: 800-507-6404
  • Fax: 877-855-3455
Mailing address:
  • Phone: 800-507-6404
  • Fax: 877-855-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number13-00119302
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number13-00119302
License Number StateNM

VIII. Authorized Official

Name: MR. PRESTON COOK
Title or Position: CFO
Credential:
Phone: 800-507-6404