Healthcare Provider Details

I. General information

NPI: 1962682450
Provider Name (Legal Business Name): CAREFREE ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10916 JUAN TABO PL NE
ALBUQUERQUE NM
87111-3987
US

IV. Provider business mailing address

10916 JUAN TABO PL NE
ALBUQUERQUE NM
87111-3987
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-8000
  • Fax: 505-299-8200
Mailing address:
  • Phone: 505-299-8000
  • Fax: 505-299-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5647
License Number StateNM

VIII. Authorized Official

Name: MRS. ESTEPHANIE JANE PETROPOULOS
Title or Position: RN
Credential: RN
Phone: 505-299-8000