Basic Information
| Provider Information | |||||||||
| NPI: | 1164531786 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAUREL MEADOWS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAUREL MEADOWS HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1831 CAMINO DEL LLANO | ||||||||
| Address2: | |||||||||
| City: | BELEN | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870022619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058641600 | ||||||||
| FaxNumber: | 5058646923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1831 CAMINO DEL LLANO | ||||||||
| Address2: | |||||||||
| City: | BELEN | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870022619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058641600 | ||||||||
| FaxNumber: | 5058646923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ZAMPINI | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5053045152 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1044 | NM | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 44133766 | 05 | NM | MEDICAID | 3200534490 | 01 | CLIA | OTHER |