Provider Demographics
NPI:1730117722
Name:LOS ALAMOS RETIREMENT CENTER, INC.
Entity Type:Organization
Organization Name:LOS ALAMOS RETIREMENT CENTER, INC.
Other - Org Name:SOMBRILLO NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, HERITAGE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-0219
Mailing Address - Street 1:1011 SOMBRILLO CT
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3246
Mailing Address - Country:US
Mailing Address - Phone:505-662-4300
Mailing Address - Fax:505-662-2630
Practice Address - Street 1:1011 SOMBRILLO CT
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3246
Practice Address - Country:US
Practice Address - Phone:505-662-4300
Practice Address - Fax:505-662-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5180313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI0571Medicaid
NMI0571Medicaid