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General NPI Number Information
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NPI Number | 1245479070
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Entity Type | Organization
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Legal Business Name | CAMEL ROCK ENTERPRISES INC.
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 1650 LOS LENTES RD NE
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City | LOS LUNAS
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State | NM
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Zip | 87031-9316
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Country | US
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Telephone | 575-273-4204
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | CAUSEY
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State | NM
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Zip | 88113-0034
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Country | US
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Telephone | 575-273-4204
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MR. LAWRENCE K. SKELLEY
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Credential |
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Telephone | 575-273-4204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 2116
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License Number State | NM
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