Healthcare Provider Details

I. General information

NPI: 1538114525
Provider Name (Legal Business Name): NAZARETH HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 RAYNOLDS ST
EL PASO TX
79903-3122
US

IV. Provider business mailing address

1475 RAYNOLDS ST
EL PASO TX
79903-3122
US

V. Phone/Fax

Practice location:
  • Phone: 915-565-4677
  • Fax: 915-565-5118
Mailing address:
  • Phone: 915-565-4677
  • Fax: 915-565-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number123868
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number0099750
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0099750
License Number StateTX

VIII. Authorized Official

Name: MRS. JOY MARTINEZ
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 915-565-4677