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General NPI Number Information
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NPI Number | 1578672424
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Entity Type | Organization
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Legal Business Name | ENCHANTED HILLS HOME HEALTHCARE AGENCY, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 7555 ENCHANTED HILLS BLVD. SUITE 200
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City | RIO RANCHO
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State | NM
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Zip | 87144-8525
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Country | US
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Telephone | 505-867-0621
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Fax | 505-867-0623
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Provider Business Mailing Address
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Address Line | 7555 ENCHANTED HILLS BLVD NE SUITE 200
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City | RIO RANCHO
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State | NM
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Zip | 87144-8625
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Country | US
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Telephone | 505-867-0621
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Fax | 505-867-0623
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELISSA KELLENE JOHNS
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Credential | RN
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Telephone | 505-867-0621
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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 | 3202
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License Number State | NM
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