Provider Demographics
NPI:1578837472
Name:EARTHWORTHY COMPASSIONATE CARE
Entity Type:Organization
Organization Name:EARTHWORTHY COMPASSIONATE CARE
Other - Org Name:NICHOLETTE DEVILBISS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVILBISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-947-2787
Mailing Address - Street 1:2808 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-7907
Mailing Address - Country:US
Mailing Address - Phone:505-947-2787
Mailing Address - Fax:
Practice Address - Street 1:714 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5639
Practice Address - Country:US
Practice Address - Phone:505-947-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service