Provider Demographics
NPI:1669209839
Name:SANDIA VIEW FOUNTAIN HILL LLC
Entity type:Organization
Organization Name:SANDIA VIEW FOUNTAIN HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-264-8120
Mailing Address - Street 1:PO BOX 22566
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-2566
Mailing Address - Country:US
Mailing Address - Phone:505-582-2906
Mailing Address - Fax:505-212-5307
Practice Address - Street 1:4551 VISTA FUENTE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3800
Practice Address - Country:US
Practice Address - Phone:505-582-2906
Practice Address - Fax:505-212-5307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JBC2 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility