Provider Demographics
NPI:1164531786
Name:LAUREL MEADOWS LLC
Entity Type:Organization
Organization Name:LAUREL MEADOWS LLC
Other - Org Name:LAUREL MEADOWS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMPINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-304-5152
Mailing Address - Street 1:1831 CAMINO DEL LLANO
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-2619
Mailing Address - Country:US
Mailing Address - Phone:505-864-1600
Mailing Address - Fax:505-864-6923
Practice Address - Street 1:1831 CAMINO DEL LLANO
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2619
Practice Address - Country:US
Practice Address - Phone:505-864-1600
Practice Address - Fax:505-864-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1044314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44133766Medicaid
3200534490OtherCLIA
NM44133766Medicaid
1528250685Medicare Oscar/Certification
1164531786Medicare Oscar/Certification