Provider Demographics
NPI:1659005171
Name:LUNA DEL VALLE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:LUNA DEL VALLE HEALTHCARE SERVICES
Other - Org Name:LUNA DEL VALLE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-573-9590
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE STE K-110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6748
Mailing Address - Country:US
Mailing Address - Phone:505-365-0321
Mailing Address - Fax:505-520-0131
Practice Address - Street 1:4273 MONTGOMERY BLVD NE STE K-110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6748
Practice Address - Country:US
Practice Address - Phone:505-365-0321
Practice Address - Fax:505-520-0131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUNA DEL VALLE HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-11
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based