Provider Demographics
NPI:1861535825
Name:NORTHERN NEW MEXICO HEALTH CARE, LLC
Entity type:Organization
Organization Name:NORTHERN NEW MEXICO HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-753-7576
Mailing Address - Street 1:82 COUNTY ROAD 122
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3187
Mailing Address - Country:US
Mailing Address - Phone:505-753-7576
Mailing Address - Fax:505-753-7676
Practice Address - Street 1:82 COUNTY ROAD 122
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3187
Practice Address - Country:US
Practice Address - Phone:505-753-7576
Practice Address - Fax:505-753-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty