Organization
SAN JUAN CENTER FOR INDEPENDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY DEAN CARVER (CHIEF FINANCIAL OFFICER)
(505) 566-5827
Entity
Organization
Contact information
Practice address
1204 SAN JUAN BLVD, FARMINGTON, NM 87401-2724
(505) 566-5827
(505) 566-5842
Mailing address
1204 SAN JUAN BLVD, FARMINGTON, NM 87401-2724
(505) 566-5827
(505) 566-5842
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z9242
—
NM
Enumeration date
08/19/2006
Last updated
10/26/2015
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