1306072822 NPI number — PREFERRED ASSISTED LIVING, INC.

Table of content: (NPI 1306072822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306072822 NPI number — PREFERRED ASSISTED LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED ASSISTED LIVING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBUQUERQUE PREFERRED ASSISTED LIVING, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306072822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 SAN MATEO BLVD NE
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-6299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-884-3830
Provider Business Mailing Address Fax Number:
505-828-1091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 SAN MATEO BLVD NE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-6299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-884-3830
Provider Business Practice Location Address Fax Number:
505-828-1091
Provider Enumeration Date:
06/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AYERS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
505-884-3830

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2064 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 2125 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 2024 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 5777 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 2065 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 2084 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 310400000X , with the licence number: 2068 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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