MEDICARE: ADELANTE DEVELOPMENT CENTER, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4045	OTHER	NM	NM DEPT OF HEALTH ASSISTED LIVING & ADULT DAY CARE LICENSE

General Provider Information

NPI Number	:	1417528647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADELANTE DEVELOPMENT CENTER, INC.

Provider Business Mailing Address
First Line	:	3900 OSUNA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4459
Country	:	US
Telephone Number	:	505-449-4039
Fax Number	:

Provider Business Practice Location Address
First Line	:	3609 LAFAYETTE DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4367
Country	:	US
Telephone Number	:	505-341-2000
Fax Number	:	505-341-2001

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	REBECCA LYNN SANFORD
Credential	:
Telephone Number	:	505-341-2000

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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