| NPI | 1487290623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL P CLEMENTS Sole Proprietor 575-973-5864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2019-12-10 |