Healthcare Provider Details

I. General information

NPI: 1710684972
Provider Name (Legal Business Name): LOS ANDES ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 RANCHO DEL CERRO DR NE
ALBUQUERQUE NM
87113-2076
US

IV. Provider business mailing address

8501 RANCHO DEL CERRO DR NE
ALBUQUERQUE NM
87113-2076
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-3307
  • Fax:
Mailing address:
  • Phone: 505-363-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAOLA GALLEGOS
Title or Position: DIRECTOR
Credential:
Phone: 505-363-3307