Healthcare Provider Details

I. General information

NPI: 1245479070
Provider Name (Legal Business Name): CAMEL ROCK ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LOS LENTES RD NE
LOS LUNAS NM
87031-9316
US

IV. Provider business mailing address

PO BOX 34
CAUSEY NM
88113-0034
US

V. Phone/Fax

Practice location:
  • Phone: 575-273-4204
  • Fax:
Mailing address:
  • Phone: 575-273-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2116
License Number StateNM

VIII. Authorized Official

Name: MR. LAWRENCE K. SKELLEY
Title or Position: OFFICER
Credential:
Phone: 575-273-4204