1093341810 NPI number — CLEARSKY REHABILITATION HOSPITAL OF RIO RANCHO LLC

Table of content: (NPI 1093341810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093341810 NPI number — CLEARSKY REHABILITATION HOSPITAL OF RIO RANCHO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARSKY REHABILITATION HOSPITAL OF RIO RANCHO LLC
Provider Last Name:
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Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1093341810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 WYOMING BLVD NE STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-3136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-295-6358
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 WESTSIDE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-317-3802
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
505-317-3988

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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