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Organization
GREAT LIVIN II LLC
Active
Organization
GREAT LIVIN II LLC
Active
Parent organization
GREAT LIVIN II LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LIVIN II LLC
Authorized official
MATT J POEL (OWNER)
(505) 246-6971
Entity
Organization
Contact information
Practice address
617 MADEIRA DR NE, ALBUQUERQUE, NM 87108-1417
(505) 246-6971
(505) 247-2191
Mailing address
2400 MONROE ST NE, ALBUQUERQUE, NM 87110-4063
(505) 246-6971
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
09/01/2021
Last updated
05/13/2024
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