Provider Demographics
NPI:1619011889
Name:MOUNTAIN SHADOWS HOME CARE SERVICES, INC
Entity Type:Organization
Organization Name:MOUNTAIN SHADOWS HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-541-3962
Mailing Address - Street 1:800 N TELSHOR BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8251
Mailing Address - Country:US
Mailing Address - Phone:505-521-1366
Mailing Address - Fax:505-521-4772
Practice Address - Street 1:800 N TELSHOR BLVD
Practice Address - Street 2:STE. B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8251
Practice Address - Country:US
Practice Address - Phone:505-521-1366
Practice Address - Fax:505-521-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD0706Medicaid
NM74452Medicaid