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General NPI Number Information
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NPI Number | 1003292228
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Entity Type | Organization
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Legal Business Name | SACRED SPIRITS HOME HEALTH
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 40 OLD LOOP
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City | CONTINENTAL DIVIDE
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State | NM
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Zip | 87312-0145
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Country | US
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Telephone | 505-240-3711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | CONTINENTAL DIVIDE
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State | NM
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Zip | 87312-0145
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Country | US
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Telephone | 505-240-3711
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Fax |
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Authorized Official
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Title or Position | HEALTH SERVICES ADMIN
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Name | MRS. TRACY JARAMILLO
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Credential | RN
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Telephone | 505-240-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | R46467
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License Number State | NM
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