Healthcare Provider Details

I. General information

NPI: 1225742315
Provider Name (Legal Business Name): PALOMA SPRINGS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SILVER ST
TRUTH OR CONSEQUENCES NM
87901-1957
US

IV. Provider business mailing address

4525 WILSHIRE BLVD STE 210
LOS ANGELES CA
90010-3846
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-7855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID GARETZ
Title or Position: CFO
Credential:
Phone: 323-987-5954