Provider Demographics
NPI:1770708174
Name:ISLETA ELDERLY SERVICES
Entity type:Organization
Organization Name:ISLETA ELDERLY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:505-869-6661
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:ISLETA
Mailing Address - State:NM
Mailing Address - Zip Code:87022-1270
Mailing Address - Country:US
Mailing Address - Phone:505-869-6661
Mailing Address - Fax:505-869-2736
Practice Address - Street 1:TRIBAL RD. 40 BLDG. 70
Practice Address - Street 2:
Practice Address - City:ISLETA
Practice Address - State:NM
Practice Address - Zip Code:87022
Practice Address - Country:US
Practice Address - Phone:505-869-6661
Practice Address - Fax:505-869-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health