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General NPI Number Information
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NPI Number | 1316940216
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HOME HEALTH CARE DE SANTA FE Y LOS ALAMOS
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 10 CALLE MEDICO
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City | SANTA FE
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State | NM
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Zip | 87505-4724
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Country | US
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Telephone | 505-982-8581
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Fax | 505-982-0788
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Provider Business Mailing Address
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Address Line | 10 CALLE MEDICO
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City | SANTA FE
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State | NM
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Zip | 87505-4724
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Country | US
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Telephone | 505-982-8581
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Fax | 505-982-0788
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. BRIAN CONWAY
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Credential | R.N.
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Telephone | 505-982-8581
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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 | 6603
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 6012 A1
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3068
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License Number State | NM
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