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General NPI Number Information
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NPI Number | 1619072915
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Entity Type | Organization
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Legal Business Name | SAN VICENTE HOME HEALTH LLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 N ARIZONA ST
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City | SILVER CITY
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State | NM
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Zip | 88061-4963
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Country | US
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Telephone | 505-538-0912
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Fax | 505-538-0917
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Provider Business Mailing Address
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Address Line | PO BOX 2307
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City | SILVER CITY
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State | NM
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Zip | 88062-2307
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Country | US
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Telephone | 505-538-0912
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Fax | 505-538-0917
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MISTY D GONZALES
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Credential | RN
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Telephone | 505-538-0912
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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 | 6549
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License Number State | NM
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