Provider Demographics
NPI:1487893012
Name:VALLEY FIRST CARE
Entity type:Organization
Organization Name:VALLEY FIRST CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-474-6097
Mailing Address - Street 1:528 N CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2790
Mailing Address - Country:US
Mailing Address - Phone:505-747-6939
Mailing Address - Fax:505-747-6816
Practice Address - Street 1:3600 RODEO LN
Practice Address - Street 2:SUITE A1
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6400
Practice Address - Country:US
Practice Address - Phone:505-474-6097
Practice Address - Fax:505-474-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46233Medicaid
NM2372251Medicare PIN