Provider Demographics
NPI: | 1790805117 |
---|---|
Name: | 800-HOMECARE, TRUSTED CARE AT HOME |
Entity Type: | Organization |
Organization Name: | 800-HOMECARE, TRUSTED CARE AT HOME |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | SHAWN |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | RICKETTS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 505-796-3200 |
Mailing Address - Street 1: | 3721 RUTLEDGE ROAD, NE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87109-5566 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-796-3200 |
Mailing Address - Fax: | 505-796-3234 |
Practice Address - Street 1: | 1065 SOUTH MAIN STREET |
Practice Address - Street 2: | BLDG. D, SUITE H |
Practice Address - City: | LAS CRUCES |
Practice Address - State: | NM |
Practice Address - Zip Code: | 88005-2909 |
Practice Address - Country: | US |
Practice Address - Phone: | 575-522-2323 |
Practice Address - Fax: | 575-522-2322 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-30 |
Last Update Date: | 2013-03-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | 03-091034-00-0 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |