Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 251E00000X | Home Health | | 6567 | NEW MEXICO | No |
| 2 | 251J00000X | Nursing Care | | 5088 | NEW MEXICO | No |
| 3 | 310400000X | Assisted Living Facility | | 5553 | NEW MEXICO | No |
| 4 | 314000000X | Skilled Nursing Facility | | 5088 | NEW MEXICO | No |
| 5 | 251G00000X | Hospice Care, Community Based | | 3000 | NEW MEXICO | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | B5046 | MEDICAID | NEW MEXICO | |
| 2 | I0381 | MEDICAID | NEW MEXICO | |
| 3 | 32-5087 | MEDICARE OSCAR/CERTIFICATION | NEW MEXICO | |
| 4 | 32-7161 | MEDICARE ID-TYPE UNSPECIFIED | NEW MEXICO | HOME HEALTH AGENCY |
| 5 | 32-1540 | MEDICARE ID-TYPE UNSPECIFIED | NEW MEXICO | HOSPICE CARE |
| 6 | N3177 | MEDICAID | NEW MEXICO | |
