Healthcare Provider Details

I. General information

NPI: 1568571198
Provider Name (Legal Business Name): ARBOR CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 CONSTITUTION AVENUE NE
ALBUQUERQUE NM
87110-7513
US

IV. Provider business mailing address

7900 CONSTITUTION AVENUE NE
ALBUQUERQUE NM
87110-7513
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-5565
  • Fax: 505-296-6659
Mailing address:
  • Phone: 505-296-5565
  • Fax: 505-296-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1051
License Number StateNM

VIII. Authorized Official

Name: MR. ALAN ZAMPINI
Title or Position: MEMBER
Credential:
Phone: 505-304-5152