Healthcare Provider Details

I. General information

NPI: 1538915632
Provider Name (Legal Business Name): MIRDOH HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PASEO DEL SOL
SANTA FE NM
87507-4072
US

IV. Provider business mailing address

3900 PASEO DEL SOL
SANTA FE NM
87507-4072
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-1000
  • Fax:
Mailing address:
  • Phone: 505-930-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. EDMUND GYANDOH
Title or Position: PRESIDENT/CEO
Credential: DBA, PMP
Phone: 505-930-1000