Provider Demographics
NPI:1275838369
Name:GENUINE HOME HEALTHCARE OF NEW MEXICO
Entity Type:Organization
Organization Name:GENUINE HOME HEALTHCARE OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-750-4335
Mailing Address - Street 1:720 LOS VIEJOS DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3312
Mailing Address - Country:US
Mailing Address - Phone:505-750-4335
Mailing Address - Fax:
Practice Address - Street 1:720 LOS VIEJOS DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3312
Practice Address - Country:US
Practice Address - Phone:505-750-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEATHER GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03208235005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health