Organization
THI OF NEW MEXICO AT VIDA ENCANTADA, LLC
Active
Other names
Vida Encantada Nursing and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON INOUE (PRESIDENT)
(505) 425-9362
Entity
Organization
Contact information
Practice address
2301 COLLINS DR, LAS VEGAS, NM 87701-4826
(505) 425-9362
(505) 425-3152
Mailing address
930 RIDGEBROOK RD, SPARKS, MD 21152-9390
(410) 773-1000
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
72654899
—
NM
Enumeration date
10/07/2006
Last updated
03/11/2008
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