Organization
LA VIDA LLENA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KONRAD VAN BAALEN (EXECUTIVE DIRECTOR)
(505) 359-1978
Entity
Organization
Contact information
Practice address
10501 LAGRIMA DE ORO RD NE, ALBUQUERQUE, NM 87111-3737
(505) 296-6700
(505) 292-8843
Mailing address
10501 LAGRIMA DE ORO RD NE, ALBUQUERQUE, NM 87111-3737
(505) 923-4001
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5061
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000I0100
—
NM
Enumeration date
07/05/2005
Last updated
12/11/2025
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