Healthcare Provider Details

I. General information

NPI: 1679980544
Provider Name (Legal Business Name): TERCER CIELO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2014
Last Update Date: 07/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 GLENWOOD HILLS DR NE
ALBUQUERQUE NM
87111-4260
US

IV. Provider business mailing address

4409 GLENWOOD HILLS DR NE
ALBUQUERQUE NM
87111-4260
US

V. Phone/Fax

Practice location:
  • Phone: 505-203-8695
  • Fax: 505-369-1238
Mailing address:
  • Phone: 505-203-8695
  • Fax: 505-369-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2229
License Number StateNM

VIII. Authorized Official

Name: CARLOS FIGUEROA
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 505-203-8695