Healthcare Provider Details

I. General information

NPI: 1225259351
Provider Name (Legal Business Name): ALBUQUERQUE MEMORY CARE COMMUNITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

3723 FAIRVIEW INDUSTRIAL DR SE SUITE 270
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-0113
  • Fax:
Mailing address:
  • Phone: 503-485-4600
  • 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: JON HARDER
Title or Position: MANAGER
Credential:
Phone: 503-485-4600