Provider Demographics
NPI:1891848131
Name:DIRECT HEALTHCARE SOUTH INC
Entity Type:Organization
Organization Name:DIRECT HEALTHCARE SOUTH INC
Other - Org Name:DIRECT HEALTHCARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:MA OTR
Authorized Official - Phone:505-589-2555
Mailing Address - Street 1:101 LIVINGSTON LOOP
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008
Mailing Address - Country:US
Mailing Address - Phone:575-589-2555
Mailing Address - Fax:575-588-2499
Practice Address - Street 1:101 LIVINGSTON LOOP
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008
Practice Address - Country:US
Practice Address - Phone:575-589-2555
Practice Address - Fax:575-588-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM19234287251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19234287Medicaid