Provider Demographics
NPI:1629187240
Name:ARBOR BROOK LLC
Entity Type:Organization
Organization Name:ARBOR BROOK LLC
Other - Org Name:ARBOR BROOK HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMPINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-304-5152
Mailing Address - Street 1:2216 LESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2607
Mailing Address - Country:US
Mailing Address - Phone:505-296-4808
Mailing Address - Fax:505-293-0398
Practice Address - Street 1:2216 LESTER DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2607
Practice Address - Country:US
Practice Address - Phone:505-296-4808
Practice Address - Fax:505-293-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1050310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06589294Medicaid
32D0535821OtherCLIA
325032Medicare Oscar/Certification
1447442512Medicare Oscar/Certification
1629187240Medicare Oscar/Certification