Healthcare Provider Details

I. General information

NPI: 1134167679
Provider Name (Legal Business Name): PALOMA BLANCA HEALTH CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2257
  • Fax: 505-247-1784
Mailing address:
  • Phone: 505-243-2257
  • Fax: 505-247-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1076
License Number StateNM

VIII. Authorized Official

Name: CATHERINE M. PANNELL
Title or Position: MANAGER
Credential:
Phone: 505-243-2257