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General NPI Number Information
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NPI Number | 1861466732
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Entity Type | Organization
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Legal Business Name | BASIN COORDINATED HEALTHCARE,INC
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 210 N ORCHARD AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-6225
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Country | US
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Telephone | 505-324-8269
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Fax | 505-324-8387
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Provider Business Mailing Address
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Address Line | 210 N ORCHARD AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-6225
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Country | US
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Telephone | 505-324-8269
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Fax | 505-324-8387
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY NELSON
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Credential |
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Telephone | 505-324-8269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6635
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 6635
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 6635
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 6635
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License Number State | NM
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