Healthcare Provider Details

I. General information

NPI: 1366613879
Provider Name (Legal Business Name): CAREGIVERS OF ALBUQUERQUE ASSISTED LIVINGS HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 FOOTHILL DR SW
ALBUQUERQUE NM
87105-4963
US

IV. Provider business mailing address

2739 FOOTHILL DR SW
ALBUQUERQUE NM
87105-4963
US

V. Phone/Fax

Practice location:
  • Phone: 505-934-0438
  • Fax:
Mailing address:
  • Phone: 505-934-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5590
License Number StateNM

VIII. Authorized Official

Name: MR. GARY LEE SANDOVAL
Title or Position: DIRECTOR
Credential:
Phone: 505-934-0438