Healthcare Provider Details

I. General information

NPI: 1407361009
Provider Name (Legal Business Name): ABQ POST ACUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 06/16/2018
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

32831 SAN JUAN CT
TEMECULA CA
92592-7115
US

V. Phone/Fax

Practice location:
  • Phone: 408-348-7566
  • Fax:
Mailing address:
  • Phone:
  • 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: DANIEL FUNK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 408-348-7566