Healthcare Provider Details

I. General information

NPI: 1063809085
Provider Name (Legal Business Name): RIO SEDILLO ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 CAMINO, LOS CHAVEZ
LOS LUNAS NM
87031
US

IV. Provider business mailing address

133 CAMINO LOS CHAVEZ
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-3267
  • Fax:
Mailing address:
  • Phone: 505-261-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2270
License Number StateNM

VIII. Authorized Official

Name: MR. ANTHONY T SEDILLO
Title or Position: OWNER
Credential: N/A
Phone: 505-261-7380