Provider Demographics
NPI:1023317930
Name:ASPEN CARE, INC.
Entity type:Organization
Organization Name:ASPEN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENTEZARI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-450-4463
Mailing Address - Street 1:PO BOX 16797
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-6797
Mailing Address - Country:US
Mailing Address - Phone:505-889-3040
Mailing Address - Fax:
Practice Address - Street 1:3225 GEORGIA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2624
Practice Address - Country:US
Practice Address - Phone:505-889-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5719310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility