=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053446849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR LIVING SYSTEMS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 04/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5A THOMAS RD
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031-7549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-8813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7207
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87194-7207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-8813
-----------------------------------------------------
Fax | 505-865-4866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. SUZETTE LINDEMUTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-865-8813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 5399
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------