Provider Demographics
NPI:1164652426
Name:COORDINATED SKILLED CARE, INC.
Entity Type:Organization
Organization Name:COORDINATED SKILLED CARE, INC.
Other - Org Name:COORDINATED HOME HEALTH SKILLED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-541-4201
Mailing Address - Street 1:205 W BOUTZ RD
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3262
Mailing Address - Country:US
Mailing Address - Phone:505-523-8885
Mailing Address - Fax:505-525-3137
Practice Address - Street 1:205 W BOUTZ RD
Practice Address - Street 2:BUILDING 6
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3262
Practice Address - Country:US
Practice Address - Phone:505-523-8885
Practice Address - Fax:505-525-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM327182Medicare Oscar/Certification