Provider Demographics
NPI:1619137650
Name:ALBUQUERQUE GRAND SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:ALBUQUERQUE GRAND SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-842-1972
Mailing Address - Street 1:1501 TIJERAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4518
Mailing Address - Country:US
Mailing Address - Phone:505-842-1972
Mailing Address - Fax:505-842-1655
Practice Address - Street 1:1501 TIJERAS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4518
Practice Address - Country:US
Practice Address - Phone:505-842-1972
Practice Address - Fax:505-842-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5544310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility