Provider Demographics
NPI:1417223751
Name:AURORA ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:AURORA ASSISTED LIVING LLC
Other - Org Name:AURORA ASSISTED LIVING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO ASSISTED
Authorized Official - Prefix:MR
Authorized Official - First Name:CUSTODIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:505-717-2472
Mailing Address - Street 1:8216 PERIDOT AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8334
Mailing Address - Country:US
Mailing Address - Phone:505-717-2472
Mailing Address - Fax:505-503-7545
Practice Address - Street 1:8216 PERIDOT AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8334
Practice Address - Country:US
Practice Address - Phone:505-717-2472
Practice Address - Fax:505-717-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2206310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility