Healthcare Provider Details

I. General information

NPI: 1043863483
Provider Name (Legal Business Name): SANDIA VIEW SPAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 ROYAL POINT CT NE
ALBUQUERQUE NM
87111-7708
US

IV. Provider business mailing address

12501 ROYAL POINT CT NE
ALBUQUERQUE NM
87111-7708
US

V. Phone/Fax

Practice location:
  • Phone: 605-681-3716
  • Fax: 844-437-2101
Mailing address:
  • Phone: 605-681-3716
  • Fax: 844-437-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: ROBYN ANN LYTLE
Title or Position: REGISTERED NURSE
Credential: MRS
Phone: 505-681-3676