Healthcare Provider Details

I. General information

NPI: 1093062440
Provider Name (Legal Business Name): ESENCIA FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 ATRISCO DR NW
ALBUQUERQUE NM
87120-1401
US

IV. Provider business mailing address

3023 ATRISCO DR NW
ALBUQUERQUE NM
87120-1401
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-9821
  • Fax:
Mailing address:
  • Phone: 505-401-9821
  • Fax:

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: IVAN GALLEGOS
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 505-401-9821