Provider Demographics
NPI:1811251267
Name:HALO HAVEN ALF LLC
Entity type:Organization
Organization Name:HALO HAVEN ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE RN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-908-7144
Mailing Address - Street 1:9401 CERRO LARGO PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1672
Mailing Address - Country:US
Mailing Address - Phone:505-908-7144
Mailing Address - Fax:505-717-1211
Practice Address - Street 1:6108 COSTA BLANCA AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5848
Practice Address - Country:US
Practice Address - Phone:505-908-7144
Practice Address - Fax:505-717-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1P2209310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility