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General NPI Number Information
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NPI Number | 1578837472
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Entity Type | Organization
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Legal Business Name | EARTHWORTHY COMPASSIONATE CARE
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 714 W MAIN ST SUITE F
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City | FARMINGTON
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State | NM
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Zip | 87401-5639
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Country | US
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Telephone | 505-947-2787
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 E CEDAR ST
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City | FARMINGTON
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State | NM
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Zip | 87401-7907
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Country | US
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Telephone | 505-947-2787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NICHOLETTE A DEVILBISS
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Credential |
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Telephone | 505-947-2787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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