Healthcare Provider Details

I. General information

NPI: 1073645602
Provider Name (Legal Business Name): ALBUQUERQUE ASSISTED LIVING, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 EUBANK BLVD NE
ALBUQUERQUE NM
87122-3385
US

IV. Provider business mailing address

7101 EUBANK BLVD NE
ALBUQUERQUE NM
87122-3385
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-8600
  • Fax: 505-797-0689
Mailing address:
  • Phone: 505-797-8600
  • Fax: 505-797-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5791
License Number StateNM

VIII. Authorized Official

Name: LAURENCE DASPIT
Title or Position: CHIEF OPERATING OFFICER AND PARTNER
Credential:
Phone: 281-362-3521