Provider Demographics
NPI:1619390333
Name:REHAB SUITES AT LAS ESTANCIAS LLC
Entity Type:Organization
Organization Name:REHAB SUITES AT LAS ESTANCIAS LLC
Other - Org Name:THE RIO AT LAS ESTANCIAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
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:318-267-6515
Mailing Address - Street 1:8820 HORIZON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1689
Mailing Address - Country:US
Mailing Address - Phone:505-998-6254
Mailing Address - Fax:505-944-7091
Practice Address - Street 1:3620 LAS ESTANCIAS DRIVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105
Practice Address - Country:US
Practice Address - Phone:505-253-9600
Practice Address - Fax:505-944-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-10-24
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
NM84738863Medicaid
NM84738863Medicaid