Healthcare Provider Details

I. General information

NPI: 1174732838
Provider Name (Legal Business Name): COORDINATED SKILLED CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N ARIZONA ST
SILVER CITY NM
88061-4963
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 6
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 505-538-0912
  • Fax: 505-538-0917
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEN MEYERS
Title or Position: PRESIDENT
Credential:
Phone: 505-524-1144