Provider Demographics
NPI:1720470123
Name:FRIENDSHIP GARDENSALF
Entity Type:Organization
Organization Name:FRIENDSHIP GARDENSALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-917-3553
Mailing Address - Street 1:1909 MORRIS ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3125
Mailing Address - Country:US
Mailing Address - Phone:505-298-1426
Mailing Address - Fax:505-503-6978
Practice Address - Street 1:1909 MORRIS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3125
Practice Address - Country:US
Practice Address - Phone:505-298-1426
Practice Address - Fax:505-503-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2201310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility