1134175383 NPI number — RUIDOSO HOME CARE, LLC

Table of content: (NPI 1134175383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134175383 NPI number — RUIDOSO HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUIDOSO HOME CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RUIDOSO HOME CARE & HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134175383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUIDOSO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88355-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-258-0028
Provider Business Mailing Address Fax Number:
575-258-2648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 GAVILAN CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUIDOSO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88345-6080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-258-0028
Provider Business Practice Location Address Fax Number:
575-258-2648
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHADWICK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATOR/OWNER
Authorized Official Telephone Number:
575-258-0028

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  3024 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , with the licence number: 3096 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A5162 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83708235 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com