Provider Demographics
NPI:1114656642
Name:RED WILLOW HOSPICE
Entity Type:Organization
Organization Name:RED WILLOW HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:DOW
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-770-5524
Mailing Address - Street 1:525 A SALAZAR ROAD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7092
Mailing Address - Country:US
Mailing Address - Phone:575-737-1811
Mailing Address - Fax:575-208-6770
Practice Address - Street 1:525 A SALAZAR ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7092
Practice Address - Country:US
Practice Address - Phone:575-737-1811
Practice Address - Fax:575-208-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based