Provider Demographics
NPI:1265879712
Name:ENCHANTED CARE SERVICES INC.
Entity type:Organization
Organization Name:ENCHANTED CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-507-6404
Mailing Address - Street 1:223 N GUADALUPE ST
Mailing Address - Street 2:SUITE 162
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1868
Mailing Address - Country:US
Mailing Address - Phone:800-507-6404
Mailing Address - Fax:877-855-3455
Practice Address - Street 1:546 HARKLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4784
Practice Address - Country:US
Practice Address - Phone:800-507-6404
Practice Address - Fax:877-855-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13-00119302251G00000X, 253Z00000X
NM251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health