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General NPI Number Information
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NPI Number | 1780025007
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Entity Type | Organization
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Legal Business Name | SOUTHWEST HOME CARE, LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 920 E SANTA FE AVE
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City | GRANTS
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State | NM
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Zip | 87020-2436
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Country | US
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Telephone | 505-287-7472
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Fax | 505-287-7473
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Provider Business Mailing Address
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Address Line | 920 E SANTA FE AVE
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City | GRANTS
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State | NM
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Zip | 87020-2436
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Country | US
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Telephone | 505-287-7472
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Fax | 505-287-7473
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | MRS. LAKEITHA C BURTON
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Credential |
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Telephone | 505-539-5290
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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 | 03-191409-00-8
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License Number State | NM
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