Provider Demographics
NPI:1518184860
Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:MORA VALLEY AMBULANCE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:RENAY
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-387-5069
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-5069
Mailing Address - Fax:575-387-9011
Practice Address - Street 1:STATE HWY 518
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732
Practice Address - Country:US
Practice Address - Phone:575-387-5069
Practice Address - Fax:575-387-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15506341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR1595Medicaid
2505699Medicare PIN