Healthcare Provider Details

I. General information

NPI: 1093928434
Provider Name (Legal Business Name): QUILTED CARE LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 LOS VOLCANES RD NW
ALBUQUERQUE NM
87121-8424
US

IV. Provider business mailing address

5353 WYOMING BLVD NE SUITE A
ALBUQUERQUE NM
87109-3132
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-0002
  • Fax: 505-831-2027
Mailing address:
  • Phone: 505-797-8735
  • Fax: 505-797-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5831
License Number StateNM

VIII. Authorized Official

Name: THOMAS J WITT JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 505-797-8735