Provider Demographics
NPI:1174868756
Name:HOME HEALTH OF NEW MEXICO
Entity type:Organization
Organization Name:HOME HEALTH OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-532-1900
Mailing Address - Street 1:125 BANK STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3311 CANDELARIA ROAD NE
Practice Address - Street 2:SUITE K
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1952
Practice Address - Country:US
Practice Address - Phone:505-344-8182
Practice Address - Fax:505-830-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health