Healthcare Provider Details

I. General information

NPI: 1700523750
Provider Name (Legal Business Name): PH OPS OF LAS ESTANCIAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 LAS ESTANCIAS DR SW
ALBUQUERQUE NM
87121-5504
US

IV. Provider business mailing address

2000 PGA BLVD STE 3230
NORTH PALM BEACH FL
33408-2718
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-9600
  • Fax:
Mailing address:
  • Phone: 561-801-4235
  • 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: SIOBAUGHN FRASER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 561-801-4235