Organization
GREAT LIVIN', LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT POEL (EXECUTIVE DIRECTOR)
(505) 620-3849
Entity
Organization
Contact information
Practice address
4213 PONDEROSA AVE NE, ALBUQUERQUE, NM 87110-1031
(505) 620-3849
Mailing address
4213 PONDEROSA AVE NE, ALBUQUERQUE, NM 87110-1031
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
86879375
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86879375
—
NM
Enumeration date
05/02/2008
Last updated
05/02/2008
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