Basic Information
| Provider Information | |||||||||
| NPI: | 1487132916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW MEXICO CARE HOLDINGS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 N PALM AVE STE 107 | ||||||||
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| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937042225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887259186 | ||||||||
| FaxNumber: | 5596679404 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 N TURNER ST | ||||||||
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| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882403833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753970870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | BIGELOW | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8887259186 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NM | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.