Organization
FIESTA PARK HEALTHCARE LLC
Active
Other names
The Medical Resort at Fiesta Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT JEREMY MARTIN (CEO)
(505) 652-1985
Entity
Organization
Contact information
Practice address
8820 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
(505) 998-1551
Mailing address
8820 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
(505) 998-1551
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17631823
—
NM
Enumeration date
10/11/2011
Last updated
12/10/2014
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