Provider Demographics
NPI:1043615925
Name:SHILOH HOME HEALTH INC
Entity Type:Organization
Organization Name:SHILOH HOME HEALTH INC
Other - Org Name:SHILOH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ADMINISTRATOR, R.N.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN,ADMINISTRATOR,
Authorized Official - Phone:505-436-3350
Mailing Address - Street 1:4301 LARGO ST STE A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8629
Mailing Address - Country:US
Mailing Address - Phone:505-436-3350
Mailing Address - Fax:505-213-1523
Practice Address - Street 1:4301 LARGO ST STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8629
Practice Address - Country:US
Practice Address - Phone:505-436-3350
Practice Address - Fax:505-213-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR52598314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility