Basic Information
Provider Information
NPI: 1073070967
EntityType: 2
ReplacementNPI:  
OrganizationName: HOSPICE OF MESILLA VALLEY, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: KINDRED HOSPICE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4060
Address2:  
City: MOORESVILLE
State: NC
PostalCode: 281174060
CountryCode: US
TelephoneNumber: 7046642876
FaxNumber:  
Practice Location
Address1: 665 E UNIVERSITY AVE BLDG 1
Address2:  
City: LAS CRUCES
State: NM
PostalCode: 880053363
CountryCode: US
TelephoneNumber: 5756801459
FaxNumber: 5755413191
Other Information
ProviderEnumerationDate: 02/27/2019
LastUpdateDate: 10/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: COMBS
AuthorizedOfficialFirstName: JANET
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP, LICENSURE
AuthorizedOfficialTelephone: 9138142013
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251G00000X  Y AgenciesHospice Care, Community Based 

No ID Information.


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