MEDICARE: DIRECTED SUPPORT SERVICES

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	253Z00000X	In Home Supportive Care Agency		NM

General Provider Information

NPI Number	:	1770936148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECTED SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	7114 MACARTHUR RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-6184
Country	:	US
Telephone Number	:	575-805-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	7114 MACARTHUR RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-6184
Country	:	US
Telephone Number	:	575-805-2516
Fax Number	:

Authorized Official
Title or Position	:	CARE GIVER
Name	:	MS. ANGIE FLORES
Credential	:
Telephone Number	:	575-805-2516

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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Directions to “DIRECTED SUPPORT SERVICES ” Practice Location

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