Provider Demographics
NPI:1134175383
Name:RUIDOSO HOME CARE, LLC
Entity type:Organization
Organization Name:RUIDOSO HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:575-258-0028
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-2019
Mailing Address - Country:US
Mailing Address - Phone:575-258-0028
Mailing Address - Fax:575-258-2648
Practice Address - Street 1:590 GAVILAN CANYON RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6080
Practice Address - Country:US
Practice Address - Phone:575-258-0028
Practice Address - Fax:575-258-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3096251G00000X
NM3024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA5162Medicaid
NM83708235Medicaid
NMA5162Medicaid
NM327178Medicare ID - Type UnspecifiedMEDICARE HOME HEALTH