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General NPI Number Information
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NPI Number | 1528363215
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTHCARE OF NORTHERN NEW MEXICO, INC.
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 1012 MILLS AVE
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City | LAS VEGAS
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State | NM
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Zip | 87701-4049
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Country | US
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Telephone | 575-522-2323
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Fax | 575-522-2322
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Provider Business Mailing Address
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Address Line | 1012 MILLS AVE
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City | LAS VEGAS
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State | NM
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Zip | 87701-4049
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Country | US
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Telephone | 575-522-2323
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Fax | 575-522-2322
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | SUSAN MARBERRY
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Credential |
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Telephone | 903-390-4040
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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 | 3358
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License Number State | NM
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