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General NPI Number Information
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NPI Number | 1770708174
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Entity Type | Organization
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Legal Business Name | ISLETA ELDERLY SERVICES
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | TRIBAL RD. 40 BLDG. 70
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City | ISLETA
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State | NM
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Zip | 87022
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Country | US
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Telephone | 505-869-6661
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Fax | 505-869-2736
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Provider Business Mailing Address
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Address Line | PO BOX 1270
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City | ISLETA
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State | NM
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Zip | 87022-1270
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Country | US
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Telephone | 505-869-6661
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Fax | 505-869-2736
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. KATHY BLACK
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Credential | M.S.
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Telephone | 505-869-6661
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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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