Provider Demographics
NPI:1649321209
Name:ROSWELL HOME HEALTH AND HOSPICE, INC
Entity type:Organization
Organization Name:ROSWELL HOME HEALTH AND HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAUB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:575-437-3500
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-0029
Mailing Address - Country:US
Mailing Address - Phone:575-437-3500
Mailing Address - Fax:575-437-2399
Practice Address - Street 1:1859 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4617
Practice Address - Country:US
Practice Address - Phone:575-437-3500
Practice Address - Fax:575-437-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6797251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML0064Medicaid
NM321509Medicare ID - Type Unspecified