Provider Demographics
NPI:1992832455
Name:NATIVE RESOURCE DEVELOPMENT COMPANY INC.
Entity type:Organization
Organization Name:NATIVE RESOURCE DEVELOPMENT COMPANY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-867-5372
Mailing Address - Street 1:318 DEE ANN AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5783
Mailing Address - Country:US
Mailing Address - Phone:505-726-0201
Mailing Address - Fax:505-726-0202
Practice Address - Street 1:318 DEE ANN AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5783
Practice Address - Country:US
Practice Address - Phone:505-726-0201
Practice Address - Fax:505-726-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM24855731253Z00000X
AZ777245253Z00000X
NM30550297343900000X
AZ073338343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43979203Medicaid
NM24855731Medicaid
NM30550297Medicaid
AZ073338Medicaid
AZ777245Medicaid