MEDICARE: CAREGIVERS OF ALBUQUERQUE ASSISTED LIVINGS HOMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	5590	NM

General Provider Information

NPI Number	:	1366613879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREGIVERS OF ALBUQUERQUE ASSISTED LIVINGS HOMES LLC

Provider Business Mailing Address
First Line	:	2739 FOOTHILL DR SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4963
Country	:	US
Telephone Number	:	505-934-0438
Fax Number	:

Provider Business Practice Location Address
First Line	:	2739 FOOTHILL DR SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4963
Country	:	US
Telephone Number	:	505-934-0438
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GARY LEE SANDOVAL
Credential	:
Telephone Number	:	505-934-0438

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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