Provider Demographics
NPI:1619569589
Name:RED MESA HOME CARE
Entity Type:Organization
Organization Name:RED MESA HOME CARE
Other - Org Name:RED MESA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-680-2698
Mailing Address - Street 1:2810 S 3640 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-5012
Mailing Address - Country:US
Mailing Address - Phone:435-680-3648
Mailing Address - Fax:
Practice Address - Street 1:2810 S 3640 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-5012
Practice Address - Country:US
Practice Address - Phone:435-467-0686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health