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NPI Code Detail

MEDICARE: THI OF NEW MEXICO AT VIDA ENCANTADA, LLC

MEDICARE: THI OF NEW MEXICO AT VIDA ENCANTADA, 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467549659
Entity Type Code : Organization
Provider Name (Legal Business Name) : THI OF NEW MEXICO AT VIDA ENCANTADA, LLC
Provider Business Mailing Address
First Line : 930 RIDGEBROOK RD
Second Line :
City : SPARKS
State : MD
Zip : 21152-9390
Country : US
Telephone Number : 410-773-1000
Fax Number :
Provider Business Practice Location Address
First Line : 2301 COLLINS DR
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4826
Country : US
Telephone Number : 505-425-9362
Fax Number : 505-425-3152
Authorized Official
Title or Position : PRESIDENT
Name : SHARON INOUE
Credential :
Telephone Number : 505-425-9362
Provider Enumeration Date : 10/07/2006
Last Update Date : 03/11/2008

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Directions to “THI OF NEW MEXICO AT VIDA ENCANTADA, LLC ” Practice Location

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