Organization
SM GANTZ OT SERVICES
Active
Organization
SM GANTZ OT SERVICES
Active
Other names
Shadow Rock Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN KEITH GANTZ NCG (GUARDIAN/OWNER)
(575) 312-0120
Entity
Organization
Contact information
Practice address
1485 N MAIN ST STE A, LAS CRUCES, NM 88001-1182
(575) 288-1969
(575) 532-9539
Mailing address
PO BOX 13907, LAS CRUCES, NM 88013-3907
(575) 288-1969
(575) 532-9539
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000082220
NATIONAL CERTIFIED GUARDIAN
NM
Enumeration date
10/07/2019
Last updated
05/21/2024
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