Organization
LITTLE SISTERS OF THE POOR OF NEW MEXICO, INC.
Active
Other names
Villa Guadalupe
Organization subpart
No
Provider details
NPI number
Authorized official
MARY THOMAS D'MELLO (DIRECTOR)
(505) 863-6894
Entity
Organization
Contact information
Practice address
1900 MARK AVE, GALLUP, NM 87301-4822
(505) 863-6894
(505) 722-4121
Mailing address
1900 MARK AVE, GALLUP, NM 87301-4822
(505) 863-6894
(505) 722-4121
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
5119
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5119
ARC LICENSE #
NM
Enumeration date
04/17/2007
Last updated
08/22/2020
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