Provider Demographics
NPI:1295211340
Name:RIP & SNORT HEALTHCARE, LLC
Entity Type:Organization
Organization Name:RIP & SNORT HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVONNA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:520-488-1756
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:PIE TOWN
Mailing Address - State:NM
Mailing Address - Zip Code:87827-0781
Mailing Address - Country:US
Mailing Address - Phone:520-488-1756
Mailing Address - Fax:888-614-3881
Practice Address - Street 1:110 SOLANO RD
Practice Address - Street 2:
Practice Address - City:PIE TOWN
Practice Address - State:NM
Practice Address - Zip Code:87827
Practice Address - Country:US
Practice Address - Phone:520-488-1756
Practice Address - Fax:888-614-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92826555Medicaid