Provider Demographics
NPI:1073584579
Name:DEMING HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:DEMING HOSPITAL CORPORATION
Other - Org Name:MIMBRES MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE OP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3840
Mailing Address - Street 1:900 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4000
Mailing Address - Country:US
Mailing Address - Phone:575-546-5800
Mailing Address - Fax:575-543-6907
Practice Address - Street 1:900 W ASH ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4000
Practice Address - Country:US
Practice Address - Phone:575-546-5800
Practice Address - Fax:575-543-6907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEMING HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-01
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5158314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM325079Medicare Oscar/Certification