Provider Demographics
NPI:1063469682
Name:ALTOMAR NEW MEXICO, LLC.
Entity Type:Organization
Organization Name:ALTOMAR NEW MEXICO, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-874-2211
Mailing Address - Street 1:5312 RIO BRAVO DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9210
Mailing Address - Country:US
Mailing Address - Phone:575-874-2211
Mailing Address - Fax:575-874-2212
Practice Address - Street 1:5312 RIO BRAVO DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9210
Practice Address - Country:US
Practice Address - Phone:575-874-2211
Practice Address - Fax:575-874-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3224251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM327192Medicare ID - Type UnspecifiedHOME HEALTH AGENCY