Healthcare Provider Details

I. General information

NPI: 1639125669
Provider Name (Legal Business Name): SILVERSTONE HEALTHCARE OF ESPANOLA VALLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E HACIENDA ST
ESPANOLA NM
87532-2523
US

IV. Provider business mailing address

101 SUN AVE NE
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-6769
  • Fax: 505-747-1589
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1028
License Number StateNM

VIII. Authorized Official

Name: WILLIAM A. MATHIES
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 505-821-3355