Provider Demographics
NPI:1205929189
Name:LAUREL HEALTHCARE LLC
Entity type:Organization
Organization Name:LAUREL HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMPINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-304-5152
Mailing Address - Street 1:103 HOSPITAL LOOP NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2115
Mailing Address - Country:US
Mailing Address - Phone:505-348-8300
Mailing Address - Fax:505-348-8270
Practice Address - Street 1:103 HOSPITAL LOOP NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2115
Practice Address - Country:US
Practice Address - Phone:505-348-8300
Practice Address - Fax:505-348-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5241314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI1175Medicaid
3200534761OtherCLIA
1205929189Medicare Oscar/Certification
3200534761OtherCLIA
325069Medicare Oscar/Certification