Organization
ENCHANTMENT LEGACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA L. MUTH (EXECUTIVE DIRECTOR)
(505) 384-3032
Entity
Organization
Contact information
Practice address
514 WILLIAMS AVE, ESTANCIA, NM 87016-0697
(505) 384-3032
(505) 384-3033
Mailing address
PO BOX 697, ESTANCIA, NM 87016-0697
(505) 384-3032
(505) 384-3033
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
172V00000X
NM
Other
Enumeration date
04/09/2015
Last updated
04/09/2015
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