Basic Information
Provider Information
NPI: 1467881649
EntityType: 2
ReplacementNPI:  
OrganizationName: ALBUQUERQUE OPERATING COMPANY LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: THE VILLAGE AT ALAMEDA
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8810 HORIZON BLVD NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871131690
CountryCode: US
TelephoneNumber: 5058577000
FaxNumber:  
Practice Location
Address1: 8810 HORIZON BLVD NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871131690
CountryCode: US
TelephoneNumber: 5058577000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/07/2013
LastUpdateDate: 04/02/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SANTORO
AuthorizedOfficialFirstName: KELLE
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: SR DIRECTOR AR
AuthorizedOfficialTelephone: 8324675728
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000X  Y Nursing & Custodial Care FacilitiesAssisted Living Facility 

No ID Information.


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