Healthcare Provider Details

I. General information

NPI: 1376677427
Provider Name (Legal Business Name): SIERRA HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N SILVER ST
TRUTH OR CONSEQUENCES NM
87901-1957
US

IV. Provider business mailing address

1400 N SILVER ST
TRUTH OR CONSEQUENCES NM
87901-1957
US

V. Phone/Fax

Practice location:
  • Phone: 505-743-1175
  • Fax:
Mailing address:
  • Phone: 505-743-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number09672320
License Number StateNM

VIII. Authorized Official

Name: ROBERT JEREMY MARTIN
Title or Position: PRESIDENT
Credential:
Phone: 505-828-0232