Provider Demographics
NPI:1992832455
Name:NATIVE RESOURCE DEVELOPMENT COMPANY INC.
Entity Type:Organization
Organization Name:NATIVE RESOURCE DEVELOPMENT COMPANY INC.
Other - Org Name:QUALITY HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-867-5372
Mailing Address - Street 1:51 JEMEZ DAM RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SANTA ANA PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6090
Mailing Address - Country:US
Mailing Address - Phone:505-867-5372
Mailing Address - Fax:505-867-5526
Practice Address - Street 1:1210 E HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4993
Practice Address - Country:US
Practice Address - Phone:505-726-8481
Practice Address - Fax:505-722-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM24855731253Z00000X
AZ777245253Z00000X
NM30550297343900000X
AZ073338343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ073338Medicaid
NM24855731Medicaid
NM30550297Medicaid
NM43979203Medicaid
AZ777245Medicaid