Healthcare Provider Details

I. General information

NPI: 1629187240
Provider Name (Legal Business Name): ARBOR BROOK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 LESTER DR NE
ALBUQUERQUE NM
87112-2607
US

IV. Provider business mailing address

2216 LESTER DR NE
ALBUQUERQUE NM
87112-2607
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-4808
  • Fax: 505-293-0398
Mailing address:
  • Phone: 505-296-4808
  • Fax: 505-293-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1050
License Number StateNM

VIII. Authorized Official

Name: MR. ALAN ZAMPINI
Title or Position: MEMBER
Credential:
Phone: 505-304-5152