Provider Demographics
NPI:1265035950
Name:EL MIRADOR HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:EL MIRADOR HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-293-5941
Mailing Address - Street 1:10801 LOMAS BLVD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5474
Mailing Address - Country:US
Mailing Address - Phone:505-293-5941
Mailing Address - Fax:505-271-0484
Practice Address - Street 1:10801 LOMAS BLVD NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5474
Practice Address - Country:US
Practice Address - Phone:505-293-5941
Practice Address - Fax:505-271-0484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL MIRADOR, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health