Provider Demographics
NPI:1659182962
Name:NEW MEXICO SUPPORT NETWORK INC
Entity type:Organization
Organization Name:NEW MEXICO SUPPORT NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:JUMA
Authorized Official - Last Name:KAP-KIRWOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-566-3803
Mailing Address - Street 1:735 S MESQUITE ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3622
Mailing Address - Country:US
Mailing Address - Phone:616-566-3803
Mailing Address - Fax:
Practice Address - Street 1:735 S MESQUITE ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3622
Practice Address - Country:US
Practice Address - Phone:616-566-3803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child