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General NPI Number Information
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NPI Number | 1891848131
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Entity Type | Organization
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Legal Business Name | DIRECT HEALTHCARE SOUTH INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 101 LIVINGSTON LOOP SUITE 5
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City | SANTA TERESA
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State | NM
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Zip | 88008
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Country | US
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Telephone | 575-589-2555
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Fax | 575-588-2499
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Provider Business Mailing Address
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Address Line | 101 LIVINGSTON LOOP SUITE 5
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City | SANTA TERESA
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State | NM
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Zip | 88008
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Country | US
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Telephone | 575-589-2555
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Fax | 575-588-2499
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RICHARD BRITO
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Credential | MA OTR
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Telephone | 505-589-2555
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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 | 19234287
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License Number State | NM
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