Provider Demographics
NPI:1104040575
Name:US DHHS CROWNPOINT HEALTHCARE FACILITY
Entity Type:Organization
Organization Name:US DHHS CROWNPOINT HEALTHCARE FACILITY
Other - Org Name:CROWNPOINT SWINGBED
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:505-786-6466
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-0358
Mailing Address - Country:US
Mailing Address - Phone:505-786-5291
Mailing Address - Fax:505-786-6440
Practice Address - Street 1:HIGHWAY 371 ROUTE 9
Practice Address - Street 2:
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313-0358
Practice Address - Country:US
Practice Address - Phone:505-786-5291
Practice Address - Fax:505-786-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32U062Medicare Oscar/Certification