Healthcare Provider Details

I. General information

NPI: 1588158380
Provider Name (Legal Business Name): LOS ALAMOS RETIRED SENIOR ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BATHTUB ROW
LOS ALAMOS NM
87544-3344
US

IV. Provider business mailing address

1101 BATHTUB ROW
LOS ALAMOS NM
87544-3344
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-0081
  • Fax:
Mailing address:
  • Phone: 505-661-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number5546
License Number StateNM

VIII. Authorized Official

Name: LAURIE HOCHHALTER
Title or Position: DAY OUT PROGRAM DIRECTOR
Credential:
Phone: 505-661-0081