Basic Information
| Provider Information | |||||||||
| NPI: | 1922044189 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NOR-LEA HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NOR-LEA HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 NORTH MAIN | ||||||||
| Address2: | |||||||||
| City: | LOVINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882602813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753966611 | ||||||||
| FaxNumber: | 5753960318 | ||||||||
| Practice Location | |||||||||
| Address1: | 2827 N. DAL PASO | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882402062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753926314 | ||||||||
| FaxNumber: | 5753928182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 01/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 5753966611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 6204A2 | NM | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | N2116 | 05 | NM | MEDICAID |