Provider Demographics
NPI:1366123549
Name:HIGH COUNTRY HOSPICE LLC
Entity type:Organization
Organization Name:HIGH COUNTRY HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-933-4456
Mailing Address - Street 1:P.O. BOX 59
Mailing Address - Street 2:
Mailing Address - City:ELEPHANT BUTTE
Mailing Address - State:NM
Mailing Address - Zip Code:87935
Mailing Address - Country:US
Mailing Address - Phone:505-933-4456
Mailing Address - Fax:
Practice Address - Street 1:600 HWY 195 SUITE D
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935
Practice Address - Country:US
Practice Address - Phone:505-933-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based