Healthcare Provider Details

I. General information

NPI: 1306072822
Provider Name (Legal Business Name): PREFERRED ASSISTED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SAN MATEO BLVD NE SUITE 114
ALBUQUERQUE NM
87109-6299
US

IV. Provider business mailing address

5500 SAN MATEO BLVD NE SUITE 114
ALBUQUERQUE NM
87109-6299
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-3830
  • Fax: 505-828-1091
Mailing address:
  • Phone: 505-884-3830
  • Fax: 505-828-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2064
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2125
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2024
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5777
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2065
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2068
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2084
License Number StateNM

VIII. Authorized Official

Name: MR. MATTHEW RAYMOND AYERS
Title or Position: OWNER/CEO
Credential:
Phone: 505-884-3830