Healthcare Provider Details

I. General information

NPI: 1023972080
Provider Name (Legal Business Name): BOSQUE TRAILS ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4631 MI CORDELIA DR NW
ALBUQUERQUE NM
87120-1849
US

IV. Provider business mailing address

1500 MONTERREY RD NE
RIO RANCHO NM
87144-1584
US

V. Phone/Fax

Practice location:
  • Phone: 505-835-3834
  • Fax: 505-557-1156
Mailing address:
  • Phone: 505-835-3834
  • Fax: 505-557-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TRANON BASHTON
Title or Position: OWNER
Credential:
Phone: 505-835-3834