Provider Demographics
NPI:1508840117
Name:MORA VALLEY COMMUNITY HEALTH SERVICES INC
Entity type:Organization
Organization Name:MORA VALLEY COMMUNITY HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-271-2201
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:877-271-2201
Mailing Address - Fax:
Practice Address - Street 1:3 MORA VALLEY CLINIC RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-2202
Practice Address - Country:US
Practice Address - Phone:877-271-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6333261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48504Medicaid
NM321803Medicare ID - Type UnspecifiedMEDICARE
NM48504Medicaid
NM321803Medicare Oscar/Certification