Provider Demographics
NPI:1003292228
Name:SACRED SPIRITS HOME HEALTH
Entity Type:Organization
Organization Name:SACRED SPIRITS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-240-3711
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:CONTINENTAL DIVIDE
Mailing Address - State:NM
Mailing Address - Zip Code:87312-0145
Mailing Address - Country:US
Mailing Address - Phone:505-240-3711
Mailing Address - Fax:
Practice Address - Street 1:40 OLD LOOP
Practice Address - Street 2:
Practice Address - City:CONTINENTAL DIVIDE
Practice Address - State:NM
Practice Address - Zip Code:87312-0145
Practice Address - Country:US
Practice Address - Phone:505-240-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR46467302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization