Healthcare Provider Details

I. General information

NPI: 1285135483
Provider Name (Legal Business Name): EC OPCO QUINTESSENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 03/12/2019
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

5885 MEADOWS RD STE 500
LAKE OSWEGO OR
97035-8646
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-8600
  • Fax:
Mailing address:
  • Phone: 971-213-4234
  • 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: AMY W. FLEMING
Title or Position: CONTROLLER
Credential:
Phone: 971-337-3922