Provider Demographics
NPI:1164794822
Name:NEW MEXICO HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:NEW MEXICO HEALTHCARE SERVICES LLC
Other - Org Name:INTERIM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-0995
Mailing Address - Street 1:3309 101ST ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-4048
Mailing Address - Country:US
Mailing Address - Phone:806-771-0995
Mailing Address - Fax:806-771-3813
Practice Address - Street 1:1008 W PIERCE ST
Practice Address - Street 2:STE 4A
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-887-9700
Practice Address - Fax:575-887-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM327156Medicare Oscar/Certification