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General NPI Number Information
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NPI Number | 1982730669
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Entity Type | Organization
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Legal Business Name | STATE OF NEW MEXICO
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 41 FORT BAYARD ROAD
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City | SANTA CLARA
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State | NM
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Zip | 88026
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Country | US
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Telephone | 575-537-8600
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Fax | 575-537-8869
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | SANTA CLARA
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State | NM
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Zip | 88026-0293
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Country | US
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Telephone | 575-537-8600
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Fax | 575-537-3753
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Authorized Official
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Title or Position | CFO
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Name | SHERRI BAYS
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Credential |
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Telephone | 575-537-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5011
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 5011
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License Number State | NM
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