Provider Demographics
NPI:1275642803
Name:LAUREL SKIES LLC
Entity Type:Organization
Organization Name:LAUREL SKIES LLC
Other - Org Name:LAUREL SKIES 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 1:9150 MCMAHON NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5201
Mailing Address - Country:US
Mailing Address - Phone:505-898-7986
Mailing Address - Fax:505-898-0024
Practice Address - Street 1:9150 MCMAHON BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5201
Practice Address - Country:US
Practice Address - Phone:505-898-7986
Practice Address - Fax:505-898-0024
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
NM1045314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56076061Medicaid
3200534490OtherCLIA
325064Medicare Oscar/Certification
NM56076061Medicaid
1275642803Medicare Oscar/Certification