# LOYAL SERVICE AGENCY INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033519897
- **Authorized official:** MRS. LONNEL M SANDOVAL-ASEBEDO R.N. (OWNER)
- **Authorized official phone:** (505) 285-2966

## Contact information

- **Practice address:** 103 GOLTZ DR, GRANTS, NM 87020-2155
- **Practice address phone:** (505) 285-2966
- **Practice address fax:** (505) 285-4055
- **Mailing address:** 103 GOLTZ DR, GRANTS, NM 87020-2155
- **Mailing address phone:** (505) 285-2966
- **Mailing address fax:** (505) 285-4055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 3351 | NM | Yes |

## Other

- **Enumeration date:** 08/29/2014
- **Last updated:** 08/29/2014