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General NPI Number Information
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NPI Number | 1770633562
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Entity Type | Organization
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Legal Business Name | SENIORCARE, LLC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 931 CAMINO RANCHITOS NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1815
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Country | US
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Telephone | 505-792-7844
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Fax |
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Provider Business Mailing Address
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Address Line | 931 CAMINO RANCHITOS NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1815
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Country | US
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Telephone | 505-792-7844
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL G BUSHNELL
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Credential |
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Telephone | 505-792-7844
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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 | 2069
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License Number State | NM
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