Healthcare Provider Details

I. General information

NPI: 1396748661
Provider Name (Legal Business Name): ZUNI HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N ROUTE BLDG #52
ZUNI NM
87327-0339
US

IV. Provider business mailing address

PO BOX 339
ZUNI NM
87327-0339
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5544
  • Fax: 505-782-5546
Mailing address:
  • Phone: 505-782-5544
  • Fax: 505-782-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6056
License Number StateNM

VIII. Authorized Official

Name: ARLEN P. QUETAWKI SR.
Title or Position: GOV./PRES. BOARD OF DIRECTORS
Credential:
Phone: 505-782-5544