Healthcare Provider Details

I. General information

NPI: 1508057209
Provider Name (Legal Business Name): PROFESSIONAL HOME HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE MEDICO
SANTA FE NM
87505-4724
US

IV. Provider business mailing address

10 CALLE MEDICO
SANTA FE NM
87505-4724
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-8581
  • Fax: 505-982-6301
Mailing address:
  • Phone: 505-982-8581
  • Fax: 505-982-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6275
License Number StateNM

VIII. Authorized Official

Name: MR. DEBBIE M CONWAY
Title or Position: OWNER/CEO
Credential: RN
Phone: 505-982-8581