Healthcare Provider Details

I. General information

NPI: 1811075484
Provider Name (Legal Business Name): TRANSITIONAL HOSPITALS CORPORATION OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HIGH ST NE
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4444
  • Fax: 505-842-5641
Mailing address:
  • Phone: 502-596-7086
  • Fax: 502-212-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number6379
License Number StateNM

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: DIR LICENSURE AND CERTIFICATICATION
Credential:
Phone: 502-596-6063