=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982014908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I & E HOME CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2014
-----------------------------------------------------
Last Update Date | 04/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 EL PASEO RD.
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-201-4336
-----------------------------------------------------
Fax | 575-636-2884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 EL PASEO RD.
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-201-4336
-----------------------------------------------------
Fax | 575-636-2884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SERGIO ESPARZA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-201-4336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 03-286769-00-07
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------