Provider Demographics
NPI:1538647615
Name:AMOR POR FAMILIA
Entity Type:Organization
Organization Name:AMOR POR FAMILIA
Other - Org Name:AMOR POR FAMILIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:505-718-2368
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:HOLMAN
Mailing Address - State:NM
Mailing Address - Zip Code:87723-0255
Mailing Address - Country:US
Mailing Address - Phone:505-718-2368
Mailing Address - Fax:
Practice Address - Street 1:46 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:CHACON
Practice Address - State:NM
Practice Address - Zip Code:87713
Practice Address - Country:US
Practice Address - Phone:505-718-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care