Healthcare Provider Details

I. General information

NPI: 1629826433
Provider Name (Legal Business Name): AMEN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 RIO BRAVO DR STE 1
SANTA TERESA NM
88008-9210
US

IV. Provider business mailing address

5312 RIO BRAVO DR STE 1
SANTA TERESA NM
88008-9210
US

V. Phone/Fax

Practice location:
  • Phone: 575-997-1027
  • Fax:
Mailing address:
  • Phone: 575-997-1027
  • 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
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SAUL SALINAS
Title or Position: MANAGING PARTNER
Credential:
Phone: 575-997-1027