Provider Demographics
NPI:1619371200
Name:RIO AT RUST CENTRE
Entity Type:Organization
Organization Name:RIO AT RUST CENTRE
Other - Org Name:THE RIO AT CABEZON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-501-7563
Mailing Address - Street 1:2410 19TH ST SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4857
Mailing Address - Country:US
Mailing Address - Phone:505-452-4200
Mailing Address - Fax:505-242-4401
Practice Address - Street 1:2410 19TH ST SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4857
Practice Address - Country:US
Practice Address - Phone:505-452-4200
Practice Address - Fax:505-242-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM325127Medicare PIN