Provider Demographics
NPI:1679651319
Name:CLOVIS HOMECARE, INC.
Entity Type:Organization
Organization Name:CLOVIS HOMECARE, INC.
Other - Org Name:COMMUNITY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-769-2243
Mailing Address - Street 1:1944 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4026
Mailing Address - Country:US
Mailing Address - Phone:575-769-2243
Mailing Address - Fax:575-762-6452
Practice Address - Street 1:1944 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4026
Practice Address - Country:US
Practice Address - Phone:575-769-2243
Practice Address - Fax:575-762-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6398251E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN2725Medicaid
NMZ7511OtherSTATE PCO PROGRAM
NMZ7511Medicaid
NMD0214Medicaid
NMD0214OtherSTATE WAIVER PROGRAM
327140AAMedicare UPIN
NMN2725Medicaid