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General NPI Number Information
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NPI Number | 1396503801
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Entity Type | Organization
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Legal Business Name | SENIOR WELLNESS HOMECARE LLC
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 1005 21ST ST SE UNIT B1
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City | RIO RANCHO
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State | NM
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Zip | 87124-4030
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Country | US
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Telephone | 505-359-3586
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Fax |
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Provider Business Mailing Address
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Address Line | 1380 RIO RANCHO BLVD SE STE 485
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City | RIO RANCHO
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State | NM
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Zip | 87124-1006
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Country | US
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Telephone | 928-255-3684
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KATRINA MAYE EUGENIO DIVIDINA
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Credential | RN
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Telephone | 928-255-3684
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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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