Provider Demographics
NPI:1710397641
Name:RAYOS DE LUZ HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:RAYOS DE LUZ HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-523-0057
Mailing Address - Street 1:133 WYATT DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2962
Mailing Address - Country:US
Mailing Address - Phone:575-523-0057
Mailing Address - Fax:575-652-3682
Practice Address - Street 1:133 WYATT DR
Practice Address - Street 2:SUITE 10
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2962
Practice Address - Country:US
Practice Address - Phone:575-523-0057
Practice Address - Fax:575-652-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM05935733Medicaid