1174732838 NPI number — COORDINATED SKILLED CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174732838 NPI number — COORDINATED SKILLED CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COORDINATED SKILLED CARE, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1174732838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W BOUTZ RD BLDG 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-3259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N ARIZONA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061-4963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-538-0912
Provider Business Practice Location Address Fax Number:
505-538-0917
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEYERS
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-524-1144

Provider Taxonomy Codes

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

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





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