Provider Demographics
NPI:1154770618
Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-356-3411
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:NM
Mailing Address - Zip Code:88124-0233
Mailing Address - Country:US
Mailing Address - Phone:575-253-4373
Mailing Address - Fax:
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:NM
Practice Address - Zip Code:88124-9680
Practice Address - Country:US
Practice Address - Phone:575-253-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3370261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health