MEDICARE: BLUE HORIZON PROPERTIES, 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

General Provider Information

NPI Number	:	1841830981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE HORIZON PROPERTIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 14297
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87191-4297
Country	:	US
Telephone Number	:	505-269-4556
Fax Number	:	800-557-3574

Provider Business Practice Location Address
First Line	:	2707 SPITZ ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1338
Country	:	US
Telephone Number	:	505-269-4556
Fax Number	:	800-557-3574

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MATT AYERS
Credential	:
Telephone Number	:	505-269-4556

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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