Provider Demographics
NPI:1861466732
Name:BASIN COORDINATED HEALTHCARE,INC
Entity Type:Organization
Organization Name:BASIN COORDINATED HEALTHCARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-324-8269
Mailing Address - Street 1:210 N ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6225
Mailing Address - Country:US
Mailing Address - Phone:505-324-8269
Mailing Address - Fax:505-324-8387
Practice Address - Street 1:210 N ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6225
Practice Address - Country:US
Practice Address - Phone:505-324-8269
Practice Address - Fax:505-324-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6635174400000X, 251E00000X, 251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD2337Medicaid
NMN2631Medicaid
NMZ8426Medicaid