Provider Demographics
NPI:1659482446
Name:LAUREL HEALTHCARE OF CLOVIS LLC
Entity Type:Organization
Organization Name:LAUREL HEALTHCARE OF CLOVIS LLC
Other - Org Name:LAUREL PLAINS 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 1:1400 WEST 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4153
Mailing Address - Country:US
Mailing Address - Phone:505-762-4705
Mailing Address - Fax:505-762-4199
Practice Address - Street 1:1400 WEST 21ST STREET
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4153
Practice Address - Country:US
Practice Address - Phone:505-762-4705
Practice Address - Fax:505-762-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1012314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48102067Medicaid
3200537311OtherCLIA
3200537311OtherCLIA
1659482446Medicare Oscar/Certification
NM48102067Medicaid