Provider Demographics
NPI:1609231448
Name:THE NEIGHBORHOOD IN RIO RANCHO
Entity Type:Organization
Organization Name:THE NEIGHBORHOOD IN RIO RANCHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:EATON-AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:505-923-4832
Mailing Address - Street 1:10701 MONTGOMERY BLVD NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3800
Mailing Address - Country:US
Mailing Address - Phone:505-923-4833
Mailing Address - Fax:505-291-3293
Practice Address - Street 1:900 LOMA COLORADO BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6511
Practice Address - Country:US
Practice Address - Phone:505-923-4833
Practice Address - Fax:505-291-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81080557Medicaid
NM4005OtherSTATE OF NM