Provider Demographics
NPI:1538985767
Name:AMPLIFIED HOME VISITING LLC
Entity type:Organization
Organization Name:AMPLIFIED HOME VISITING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DESTRE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-535-2499
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:CLIFF
Mailing Address - State:NM
Mailing Address - Zip Code:88028-0086
Mailing Address - Country:US
Mailing Address - Phone:575-535-2499
Mailing Address - Fax:575-535-2493
Practice Address - Street 1:2901 HUTTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4562
Practice Address - Country:US
Practice Address - Phone:505-325-9109
Practice Address - Fax:505-325-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care