MEDICARE: WJS NEW MEXICO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency
4	251X00000X	Supports Brokerage Agency
5	252Y00000X	Early Intervention Provider Agency
6	253J00000X	Foster Care Agency
7	253Z00000X	In Home Supportive Care Agency
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1316252174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WJS NEW MEXICO

Provider Business Mailing Address
First Line	:	2205 MIGUEL CHAVEZ RD
Second Line	:	SUITE F
City	:	SANTA FE
State	:	NM
Zip	:	87505-6914
Country	:	US
Telephone Number	:	505-954-1093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 MIGUEL CHAVEZ RD
Second Line	:	SUITE F
City	:	SANTA FE
State	:	NM
Zip	:	87505-6914
Country	:	US
Telephone Number	:	505-954-1093
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ANNE MARIE NIKON
Credential	:	MA
Telephone Number	:	778-899-3422

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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Directions to “WJS NEW MEXICO ” Practice Location

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