Provider Demographics
NPI:1417528647
Name:ADELANTE DEVELOPMENT CENTER, INC.
Entity Type:Organization
Organization Name:ADELANTE DEVELOPMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-341-2000
Mailing Address - Street 1:3900 OSUNA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4459
Mailing Address - Country:US
Mailing Address - Phone:505-449-4039
Mailing Address - Fax:
Practice Address - Street 1:3609 LAFAYETTE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4367
Practice Address - Country:US
Practice Address - Phone:505-341-2000
Practice Address - Fax:505-341-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADELANTE DEVELOPMENT CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4045OtherNM DEPT OF HEALTH ASSISTED LIVING & ADULT DAY CARE LICENSE