Healthcare Provider Details

I. General information

NPI: 1770633562
Provider Name (Legal Business Name): SENIORCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 CAMINO RANCHITOS NW
ALBUQUERQUE NM
87114-1815
US

IV. Provider business mailing address

931 CAMINO RANCHITOS NW
ALBUQUERQUE NM
87114-1815
US

V. Phone/Fax

Practice location:
  • Phone: 505-792-7844
  • Fax:
Mailing address:
  • Phone: 505-792-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2069
License Number StateNM

VIII. Authorized Official

Name: MR. PAUL G BUSHNELL
Title or Position: PRESIDENT
Credential:
Phone: 505-792-7844