Healthcare Provider Details

I. General information

NPI: 1730092875
Provider Name (Legal Business Name): TLC ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 ALDEA AVE NW
ALBUQUERQUE NM
87114-5883
US

IV. Provider business mailing address

8513 YEAGER DR NE
ALBUQUERQUE NM
87109-5135
US

V. Phone/Fax

Practice location:
  • Phone: 505-589-5778
  • Fax: 505-717-1797
Mailing address:
  • Phone: 505-589-5778
  • Fax: 505-717-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSCELYN NGUYEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-589-5778