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NPI Code Detail

MEDICARE: LOS ALAMOS VISITING NURSE SERVICE, INC.

MEDICARE: LOS ALAMOS VISITING NURSE SERVICE, INC.
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
1251E00000XHome Health Agency6036NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1011797486000OTHERNMNMCRS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962400663
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOS ALAMOS VISITING NURSE SERVICE, INC.
Provider Business Mailing Address
First Line : 109 CENTRAL PARK SQ
Second Line :
City : LOS ALAMOS
State : NM
Zip : 87544-4020
Country : US
Telephone Number : 505-662-2525
Fax Number : 505-662-7390
Provider Business Practice Location Address
First Line : 109 CENTRAL PARK SQ
Second Line :
City : LOS ALAMOS
State : NM
Zip : 87544-4020
Country : US
Telephone Number : 505-662-2525
Fax Number : 505-662-7390
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : WENDI WOLFE
Credential : R.N.
Telephone Number : 505-662-2525
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/23/2019

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