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General NPI Number Information
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NPI Number | 1003044629
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Entity Type | Organization
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Legal Business Name | SPECIAL CARE AT HOME, INC
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 1020 WEST MALONEY SUITE B
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-726-2890
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Fax | 505-722-8941
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Provider Business Mailing Address
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Address Line | PO BOX 4554
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City | YATAHEY
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State | NM
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Zip | 87375
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Country | US
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Telephone | 505-726-2890
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Fax | 505-722-8941
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | MRS. KATHERINE BENALLY
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Credential |
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Telephone | 505-726-2890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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