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General NPI Number Information
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NPI Number | 1235324815
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Entity Type | Organization
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Legal Business Name | ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 1412 SOUTH AVENUE O SUITE B
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City | PORTALES
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State | NM
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Zip | 88130-7091
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Country | US
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Telephone | 505-226-4663
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Fax | 505-226-4664
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Provider Business Mailing Address
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Address Line | PO BOX 868
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City | PORTALES
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State | NM
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Zip | 88130-0868
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Country | US
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Telephone | 505-226-4663
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Fax | 505-226-4664
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Authorized Official
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Title or Position | DIRECTOR
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Name | GARY PARTIN
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Credential |
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Telephone | 505-226-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3178
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License Number State | NM
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