| NPI | 1750699906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL T. BERG Assistant Secretary 505-468-4752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MD 16-019) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 16019) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2018-03-07 |