Basic Information
| Provider Information | |||||||||
| NPI: | 1477752806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA FE NURSING OPERATIONS, LLC | ||||||||
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| OtherOrganizationName: | SANTA FE CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W 7TH ST STE 415 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173354111 | ||||||||
| FaxNumber: | 8173350800 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 HARKLE RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059848313 | ||||||||
| FaxNumber: | 5059842542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 02/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | KENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8173354111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1063 | NM | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 96786825 | 05 | NM | MEDICAID |