Healthcare Provider Details

I. General information

NPI: 1902531080
Provider Name (Legal Business Name): CD-MS (RIO RANCHO) LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 GOLF COURSE RD SE
RIO RANCHO NM
87124-4971
US

IV. Provider business mailing address

2301 GOLF COURSE RD SE
RIO RANCHO NM
87124-4971
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-0747
  • Fax:
Mailing address:
  • Phone:
  • 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: PATRICIA FARIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-859-8050