MEDICARE: WHITE HORSE STUDIO, 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	104100000X	Social Worker	C-05502	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376035873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE HORSE STUDIO, LLC

Provider Business Mailing Address
First Line	:	135 WHITTINGTON PL
Second Line	:
City	:	ANTHONY
State	:	NM
Zip	:	88021-9270
Country	:	US
Telephone Number	:	915-588-7290
Fax Number	:	575-613-7243

Provider Business Practice Location Address
First Line	:	2410 S ESPINA ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5612
Country	:	US
Telephone Number	:	915-588-7290
Fax Number	:	575-613-7243

Authorized Official
Title or Position	:	CREDENTIALLING
Name	:	DONNA GALLEGOS
Credential	:
Telephone Number	:	575-202-0750

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	05/31/2018

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Directions to “WHITE HORSE STUDIO, LLC ” Practice Location

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