MEDICARE: THE ARISTOCRAT OF LAS CRUCES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	5772	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528102845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARISTOCRAT OF LAS CRUCES, LLC

Provider Business Mailing Address
First Line	:	800 N TELSHOR BLVD
Second Line	:	STE. A
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8251
Country	:	US
Telephone Number	:	505-521-3326
Fax Number	:	505-521-4772

Provider Business Practice Location Address
First Line	:	1111 E MOUNTAIN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2746
Country	:	US
Telephone Number	:	505-527-2795
Fax Number	:	505-521-4772

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOHN ERIC MUNSON
Credential	:
Telephone Number	:	505-521-3326

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/22/2020

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