1578672424 NPI number — ENCHANTED HILLS HOME HEALTHCARE AGENCY, 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 1578672424 NPI number — ENCHANTED HILLS HOME HEALTHCARE AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCHANTED HILLS HOME HEALTHCARE AGENCY, 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:
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:
1578672424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7555 ENCHANTED HILLS BLVD NE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RIO RANCHO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87144-8625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-867-0621
Provider Business Mailing Address Fax Number:
505-867-0623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7555 ENCHANTED HILLS BLVD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87144-8525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-867-0621
Provider Business Practice Location Address Fax Number:
505-867-0623
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNS
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
KELLENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-867-0621

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  3202 , 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)

  • Identifier: 75208067 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94935505 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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