Provider Demographics
NPI:1982951729
Name:FAMILIAS DE LUZ SUPPORTIVE & ASSISTED LIVING
Entity Type:Organization
Organization Name:FAMILIAS DE LUZ SUPPORTIVE & ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OCELOTL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-417-1355
Mailing Address - Street 1:422 ALCAZAR ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2010
Mailing Address - Country:US
Mailing Address - Phone:505-417-1355
Mailing Address - Fax:
Practice Address - Street 1:422 ALCAZAR ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2010
Practice Address - Country:US
Practice Address - Phone:505-417-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care