Organization
GREAT LIVIN II LLC
Active
Parent organization
GREAT LIVIN II LLC
Other names
Great Livin II
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LIVIN II LLC
Authorized official
MATT POEL (OWNER)
(505) 246-6971
Entity
Organization
Contact information
Practice address
4028 MESCALERO RD NE, ALBUQUERQUE, NM 87110-1754
(505) 246-6971
(505) 247-2191
Mailing address
2400 MONROE ST NE, ALBUQUERQUE, NM 87110-4063
(505) 246-6971
(505) 247-2191
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49852591
—
NM
Enumeration date
05/17/2019
Last updated
05/13/2024
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