Provider Demographics
NPI:1003284340
Name:CDR LEASING LLC
Entity Type:Organization
Organization Name:CDR LEASING LLC
Other - Org Name:CASA DE ROSA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANGER/LICENSE CLERK
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GIOVANNI
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-897-2322
Mailing Address - Street 1:10127 GUADALUPE TRL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2014
Mailing Address - Country:US
Mailing Address - Phone:505-897-2322
Mailing Address - Fax:505-922-8759
Practice Address - Street 1:10127 GUADALUPE TRL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-2014
Practice Address - Country:US
Practice Address - Phone:505-897-2322
Practice Address - Fax:505-922-8759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA DE ROSA ACQUISITIONS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2265310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility