Provider Demographics
NPI:1962682450
Name:CAREFREE ASSISTED LIVING
Entity Type:Organization
Organization Name:CAREFREE ASSISTED LIVING
Other - Org Name:CAREFREE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTEPHANIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PETROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-299-8000
Mailing Address - Street 1:10916 JUAN TABO PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3987
Mailing Address - Country:US
Mailing Address - Phone:505-299-8000
Mailing Address - Fax:505-299-8200
Practice Address - Street 1:10916 JUAN TABO PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3987
Practice Address - Country:US
Practice Address - Phone:505-299-8000
Practice Address - Fax:505-299-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5647310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
37880268OtherDISABLE/ELDERLY WAIVER NM AGING & LONG TERM SERVICES