| NPI | 1992087092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA F FISK Administrator 575-808-1656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: NM 2178) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |