1548801517 NPI number — BROOKDALE PLACE OF ALBUQUERQUE, LLC

Table of content: (NPI 1548801517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548801517 NPI number — BROOKDALE PLACE OF ALBUQUERQUE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKDALE PLACE OF ALBUQUERQUE, LLC
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:
Provider Other Organization Name Type Code:
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:
1548801517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4910 TRAMWAY RIDGE DR NE
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:
87111-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4910 TRAMWAY RIDGE DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87111-8200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-271-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LESKOWICZ
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
414-918-5000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2162 . This is a "DEPARTMENT OF HEALTH - OPERATOR'S LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 2161 . This is a "DEPARTMENT OF HEALTH - OPERATOR'S LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".