Provider Demographics
NPI:1104155753
Name:HERITAGE HEALTHCARE OF NORTHERN NEW MEXICO, INC
Entity type:Organization
Organization Name:HERITAGE HEALTHCARE OF NORTHERN NEW MEXICO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-390-4040
Mailing Address - Street 1:1012 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4049
Mailing Address - Country:US
Mailing Address - Phone:575-522-2323
Mailing Address - Fax:575-522-2322
Practice Address - Street 1:1012 MILLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4049
Practice Address - Country:US
Practice Address - Phone:575-522-2323
Practice Address - Fax:575-522-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM002570251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health