Provider Demographics
NPI:1922735778
Name:ENCHANTMENT ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ENCHANTMENT ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-445-7007
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-1524
Mailing Address - Country:US
Mailing Address - Phone:510-504-3419
Mailing Address - Fax:
Practice Address - Street 1:251 FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3721
Practice Address - Country:US
Practice Address - Phone:575-445-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility