Provider Demographics
NPI:1629951702
Name:OPEN RANGE MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:OPEN RANGE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-531-0202
Mailing Address - Street 1:405 PASEO DE PERALTA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1938
Mailing Address - Country:US
Mailing Address - Phone:831-454-6977
Mailing Address - Fax:505-772-9077
Practice Address - Street 1:405 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1938
Practice Address - Country:US
Practice Address - Phone:831-454-6977
Practice Address - Fax:505-772-9077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIGHTINGALE NURSING AND HOME HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies