MEDICARE: ST. THERESA HEALTHCARE AND REHABILITATION CENTER, 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	314000000X	Skilled Nursing Facility	1064	NM

General Provider Information

NPI Number	:	1700078870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. THERESA HEALTHCARE AND REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	7900 CONSTITUTION AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7513
Country	:	US
Telephone Number	:	505-296-5565
Fax Number	:	505-296-6659

Provider Business Practice Location Address
First Line	:	7900 CONSTITUTION AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7513
Country	:	US
Telephone Number	:	505-296-5565
Fax Number	:	505-296-6659

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	MICHAEL T. BERG
Credential	:
Telephone Number	:	505-468-4752

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	01/26/2016

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