Healthcare Provider Details

I. General information

NPI: 1619892809
Provider Name (Legal Business Name): MEADOW CITY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 4TH ST
LAS VEGAS NM
87701-4422
US

IV. Provider business mailing address

813 4TH ST
LAS VEGAS NM
87701-4422
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-9492
  • Fax:
Mailing address:
  • Phone: 505-429-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: FABIAN MONTANO
Title or Position: OWNER
Credential:
Phone: 505-429-9492