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General NPI Number Information
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NPI Number | 1043615925
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Entity Type | Organization
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Legal Business Name | SHILOH HOME HEALTH INC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 4301 LARGO ST STE A
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City | FARMINGTON
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State | NM
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Zip | 87402-8629
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Country | US
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Telephone | 505-436-3350
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Fax | 505-213-1523
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Provider Business Mailing Address
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Address Line | 4301 LARGO ST STE A
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City | FARMINGTON
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State | NM
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Zip | 87402-8629
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Country | US
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Telephone | 505-436-3350
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Fax | 505-213-1523
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR, R.N.
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Name | MRS. SARA L GONZALES
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Credential | R.N.,ADMINISTRATOR,
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Telephone | 505-436-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | R52598
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License Number State | NM
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