# THI OF NEW MEXICO AT SUNSET VILLA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sunset Villa Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013004209
- **Authorized official:** BUFFY ITOMITSU (PRESIDENT)
- **Authorized official phone:** (505) 623-7097

## Contact information

- **Practice address:** 1515 S SUNSET AVE, ROSWELL, NM 88203-2628
- **Practice address phone:** (505) 623-7097
- **Practice address fax:** (505) 624-1307
- **Mailing address:** 930 RIDGEBROOK RD, SPARKS, MD 21152-9390
- **Mailing address phone:** (410) 773-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 10/07/2006
- **Last updated:** 04/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 87001055 | — | NM |