Healthcare Provider Details

I. General information

NPI: 1225304637
Provider Name (Legal Business Name): NURSES WITH HEART HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1596 PACHECO ST STE 109
SANTA FE NM
87505-3960
US

IV. Provider business mailing address

1596 PACHECO ST STE 109
SANTA FE NM
87505-3960
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-9099
  • Fax: 505-424-9733
Mailing address:
  • Phone: 505-424-9099
  • Fax: 505-424-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3389
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ELAIS PONTON
Title or Position: CHIEF NURSING OFFICER
Credential: RN
Phone: 505-424-9099