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General NPI Number Information
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NPI Number | 1972500957
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Entity Type | Organization
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Legal Business Name | LA VIDA LLENA
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 10501 LAGRIMA DE ORO RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3737
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Country | US
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Telephone | 505-296-6700
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Fax | 505-292-8843
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Provider Business Mailing Address
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Address Line | 10501 LAGRIMA DE ORO RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3737
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Country | US
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Telephone | 505-923-4001
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ANTHONY SABATINI
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Credential |
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Telephone | 971-221-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5061
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License Number State | NM
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