Healthcare Provider Details

I. General information

NPI: 1073485314
Provider Name (Legal Business Name): SPANISH TRAILS WELLNESS & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7047
US

IV. Provider business mailing address

1610 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7047
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-4800
  • Fax:
Mailing address:
  • Phone: 505-600-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID GARETZ
Title or Position: CFO
Credential:
Phone: 323-987-5954