Provider Demographics
NPI:1699820068
Name:SOUTHWESTERN HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-216-3785
Mailing Address - Street 1:2232 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8801
Mailing Address - Country:US
Mailing Address - Phone:405-216-3785
Mailing Address - Fax:405-216-0488
Practice Address - Street 1:408 N AUBURN AVE STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5816
Practice Address - Country:US
Practice Address - Phone:505-326-6024
Practice Address - Fax:505-327-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6547251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN2742Medicaid
NMN2742Medicaid