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General NPI Number Information
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NPI Number | 1417215112
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Entity Type | Organization
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Legal Business Name | AN OPEN DOOR
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 5818 NUNATAK PL
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City | LAS CRUCES
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State | NM
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Zip | 88012-7929
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Country | US
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Telephone | 575-382-2170
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Fax | 575-373-0121
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Provider Business Mailing Address
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Address Line | 5818 NUNATAK PL
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City | LAS CRUCES
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State | NM
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Zip | 88012-7929
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Country | US
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Telephone | 575-382-2170
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Fax | 575-373-0121
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARK CHAVEZ I
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Credential |
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Telephone | 575-382-2107
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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 |
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License Number State |
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