Provider Demographics
NPI:1225173230
Name:LANDSUN HOMES INC
Entity Type:Organization
Organization Name:LANDSUN HOMES INC
Other - Org Name:LANDSUN HOMECARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:505-234-5830
Mailing Address - Street 1:1815 WESTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3507
Mailing Address - Country:US
Mailing Address - Phone:505-234-5830
Mailing Address - Fax:505-234-5850
Practice Address - Street 1:1815 WESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3507
Practice Address - Country:US
Practice Address - Phone:505-234-5830
Practice Address - Fax:505-234-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6591251E00000X
NM3108251G00000X
NM5065313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N3125Medicaid
NM000I0399Medicaid
NM76183050Medicaid
NM000I0399Medicaid
NM321546Medicare Oscar/Certification
NM327156Medicare ID - Type UnspecifiedHOMECARE
NM327156Medicare Oscar/Certification