Provider Demographics
NPI:1700864204
Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC
Other - Org Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC CARDID DE SAN ANTONIO HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER CARDID DE SAN ANTONI
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-387-6078
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:STATE HWY 518 MM 26
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-5069
Mailing Address - Fax:575-387-9011
Practice Address - Street 1:STATE HIGHWAY 518 MILEMARKER 26
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-0209
Practice Address - Country:US
Practice Address - Phone:575-387-6078
Practice Address - Fax:575-387-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6008251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN1433Medicaid
327071Medicare ID - Type UnspecifiedPROVIDER NUMBER