Healthcare Provider Details

I. General information

NPI: 1972716413
Provider Name (Legal Business Name): QUILTED CARE LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5847
US

IV. Provider business mailing address

12101 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5847
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-9976
  • Fax: 505-298-0641
Mailing address:
  • Phone: 505-298-9976
  • Fax: 505-298-0641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5882
License Number StateNM

VIII. Authorized Official

Name: THOMAS J WITT JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 505-797-8735