Provider Demographics
NPI:1225396625
Name:PRIMAVERA HOME HEALTH OF NEW MEXICO
Entity type:Organization
Organization Name:PRIMAVERA HOME HEALTH OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:915-474-0390
Mailing Address - Street 1:1242 S TRIVIZ DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-4443
Mailing Address - Country:US
Mailing Address - Phone:915-474-0390
Mailing Address - Fax:
Practice Address - Street 1:1242 S TRIVIZ DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4443
Practice Address - Country:US
Practice Address - Phone:915-474-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health