Provider Demographics
NPI:1528226149
Name:NEZZY CARE OF LAS CRUCES
Entity Type:Organization
Organization Name:NEZZY CARE OF LAS CRUCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:1575-541-0623
Mailing Address - Street 1:904 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1977
Mailing Address - Country:US
Mailing Address - Phone:157-554-1062
Mailing Address - Fax:575-525-9459
Practice Address - Street 1:904 PALMER RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1977
Practice Address - Country:US
Practice Address - Phone:157-554-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03099907003251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03099907003Medicaid