Healthcare Provider Details

I. General information

NPI: 1891258539
Provider Name (Legal Business Name): ABAL, LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SUNSET
LOGAN NM
88426-9681
US

IV. Provider business mailing address

400 SUNSET
LOGAN NM
88426-9681
US

V. Phone/Fax

Practice location:
  • Phone: 575-487-2300
  • Fax: 575-487-2302
Mailing address:
  • Phone: 575-487-2300
  • Fax: 575-487-2302

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: MRS. JEANELL WILLIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-487-2300