Healthcare Provider Details

I. General information

NPI: 1508042797
Provider Name (Legal Business Name): CASA DE ROSA ASSISTED LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 GUADALUPE TRL NW
ALBUQUERQUE NM
87114-2014
US

IV. Provider business mailing address

10127 GUADALUPE TR NW
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-2322
  • Fax:
Mailing address:
  • Phone: 505-897-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number89351321
License Number State

VIII. Authorized Official

Name: RUDY J CHAVEZ
Title or Position: DIRECTOR
Credential:
Phone: 505-897-2322