| NPI | 1639123656 |
|---|---|
| Doing Business As | THE LODGE SENIOR LIVING CENTER |
| Entity Type | Organization |
| Authorized Contact | WILLIAM A. MATHIES President Director 505-821-3355 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MT 10488) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2009-09-28 |