Provider Demographics
NPI:1528386513
Name:NEW MEXICO HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:NEW MEXICO HEALTHCARE SERVICES, LLC
Other - Org Name:INTERIM HEALTHCARE OF PORTALES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE BOARD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-771-0995
Mailing Address - Street 1:3223 S LOOP 289 STE 210
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1352
Mailing Address - Country:US
Mailing Address - Phone:806-771-0995
Mailing Address - Fax:806-771-3813
Practice Address - Street 1:1608 E SPRUCE ST STE 700
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9510
Practice Address - Country:US
Practice Address - Phone:575-226-4663
Practice Address - Fax:575-226-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3341OtherSTATE OPERATOR LICENSE
NM91628873Medicaid