Organization
MEDISOURCE HOME HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA L THOMPSON-RAMIREZ RN (ADMINISTRATOR/OWNER)
(575) 910-5521
Entity
Organization
Contact information
Practice address
406 W COLLEGE BLVD STE A, ROSWELL, NM 88201-5114
(575) 910-5521
(575) 208-1769
Mailing address
406 W COLLEGE BLVD STE A, ROSWELL, NM 88201-5114
(575) 910-5521
(575) 208-1769
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
3434
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1T3434
NM HEALTH AND LICENSING
NM
05
—
70683255
—
NM
Enumeration date
04/15/2013
Last updated
03/17/2018
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