Basic Information
| Provider Information | |||||||||
| NPI: | 1578933396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARMADA SKILLED HOMECARE OF NEW MEXICO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WARRENVILLE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302963400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 WILSHIRE AVE NE STE Y | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871132569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058472388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2015 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DARBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP CHIEF STRATEGY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6302963400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 86423266 | 05 | NM | MEDICAID |