Healthcare Provider Details

I. General information

NPI: 1285856286
Provider Name (Legal Business Name): WELLESLEY CARE HOME 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

3209 WELLESLEY CT NE
ALBUQUERQUE NM
87107-4416
US

IV. Provider business mailing address

2705 PALO VERDE DR NE
ALBUQUERQUE NM
87112-2128
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-8007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2109
License Number StateNM

VIII. Authorized Official

Name: MICHELLE REEVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-463-2475