MEDICARE: SACRED SOULS HOME HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275885006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED SOULS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	8115 RIO GRANDE BLVD NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87114-1218
Country	:	US
Telephone Number	:	505-730-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	8115 RIO GRANDE BLVD NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87114-1218
Country	:	US
Telephone Number	:	505-730-0356
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	MR. HARCHARAN SINGH
Credential	:
Telephone Number	:	505-730-0356

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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