Provider Demographics
NPI:1487096491
Name:LAS CRUCES HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:LAS CRUCES HOME CARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:3948 E LOHMAN AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8153
Mailing Address - Country:US
Mailing Address - Phone:575-652-3867
Mailing Address - Fax:
Practice Address - Street 1:3948 E LOHMAN AVE
Practice Address - Street 2:STE 3
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8153
Practice Address - Country:US
Practice Address - Phone:575-652-3867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3483251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM327212Medicare Oscar/Certification