Healthcare Provider Details

I. General information

NPI: 1144336041
Provider Name (Legal Business Name): HIGHLAND NAVAJO OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8.5 MI N. OF THOREAU HWY 371 RR881A
THOREAU NM
87323-1078
US

IV. Provider business mailing address

PO BOX 1078
THOREAU NM
87323-1078
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-7550
  • Fax: 505-786-7551
Mailing address:
  • Phone: 505-786-7550
  • Fax: 505-786-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3578
License Number StateNM

VIII. Authorized Official

Name: MRS. FRAN GEORGE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 505-786-7550