# FIESTA PARK HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Medical Resort at Fiesta Park
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962787812
- **Authorized official:** MR. ROBERT JEREMY MARTIN (CEO)
- **Authorized official phone:** (505) 652-1985

## Contact information

- **Practice address:** 8820 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
- **Practice address phone:** (505) 998-1551
- **Mailing address:** 8820 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
- **Mailing address phone:** (505) 998-1551

## Taxonomy

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

## Other

- **Enumeration date:** 10/11/2011
- **Last updated:** 12/10/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 17631823 | — | NM |