Provider Demographics
NPI:1316148430
Name:IDEAL HOME CARE, INC.
Entity type:Organization
Organization Name:IDEAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-747-4440
Mailing Address - Street 1:706 LA JOYA ST
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2877
Mailing Address - Country:US
Mailing Address - Phone:505-747-4440
Mailing Address - Fax:505-747-4443
Practice Address - Street 1:706 LA JOYA ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2877
Practice Address - Country:US
Practice Address - Phone:505-747-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000A0231Medicaid