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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