Healthcare Provider Details

I. General information

NPI: 1164531786
Provider Name (Legal Business Name): LAUREL MEADOWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 CAMINO DEL LLANO
BELEN NM
87002-2619
US

IV. Provider business mailing address

1831 CAMINO DEL LLANO
BELEN NM
87002-2619
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-1600
  • Fax: 505-864-6923
Mailing address:
  • Phone: 505-864-1600
  • Fax: 505-864-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1044
License Number StateNM

VIII. Authorized Official

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