Healthcare Provider Details

I. General information

NPI: 1982295960
Provider Name (Legal Business Name): SHP VI ALBUQUERQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SAN VICENTE AVE NE
ALBUQUERQUE NM
87109-2790
US

IV. Provider business mailing address

6901 SAN VICENTE AVE NE
ALBUQUERQUE NM
87109-2790
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-9200
  • Fax:
Mailing address:
  • Phone: 505-445-9200
  • Fax:

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: DAVID FRESHWATER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 520-392-7624