Healthcare Provider Details

I. General information

NPI: 1356747869
Provider Name (Legal Business Name): ENCHANTED CARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 BELLEVUE ST NW
ALBUQUERQUE NM
87114-4112
US

IV. Provider business mailing address

9921 BELLEVUE ST NW
ALBUQUERQUE NM
87114-4112
US

V. Phone/Fax

Practice location:
  • Phone: 800-507-6404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1T 2248
License Number StateNM

VIII. Authorized Official

Name: ELLEN BANKS
Title or Position: DIRECTOR
Credential:
Phone: 800-507-6404