Healthcare Provider Details

I. General information

NPI: 1740751304
Provider Name (Legal Business Name): THE WOODMARK AT UPTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 PROSPECT PL NE
ALBUQUERQUE NM
87110-4238
US

IV. Provider business mailing address

7201 PROSPECT PL NE
ALBUQUERQUE NM
87110-4238
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-0120
  • Fax: 505-881-3450
Mailing address:
  • Phone: 505-881-0120
  • Fax: 505-881-3450

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: LAURA MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 505-881-0120