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General NPI Number Information
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NPI Number | 1811251267
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Entity Type | Organization
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Legal Business Name | HALO HAVEN ALF LLC
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 6108 COSTA BLANCA AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5848
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Country | US
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Telephone | 505-908-7144
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Fax | 505-717-1211
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Provider Business Mailing Address
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Address Line | 9401 CERRO LARGO PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1672
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Country | US
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Telephone | 505-908-7144
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Fax | 505-717-1211
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Authorized Official
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Title or Position | ADMINISTRATIVE RN/OWNER
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Name | ANGEL H MCDOWELL
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Credential | RN
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Telephone | 505-908-7144
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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 | 1P2209
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License Number State | NM
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