Healthcare Provider Details

I. General information

NPI: 1164639027
Provider Name (Legal Business Name): EL CASTILLO RETIREMENT RESIDENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E ALAMEDA ST
SANTA FE NM
87501-2186
US

IV. Provider business mailing address

250 E ALAMEDA ST
SANTA FE NM
87501-2186
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2877
  • Fax:
Mailing address:
  • Phone: 505-988-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5043
License Number StateNM

VIII. Authorized Official

Name: ALLEN JAHNER
Title or Position: CEO
Credential:
Phone: 505-988-2877