Organization
GREAT LIVIN II LLC
Active
Parent organization
GREAT LIVIN II LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LIVIN II LLC
Authorized official
MATT J POEL (OWNER)
(505) 246-6971
Entity
Organization
Contact information
Practice address
617 MADEIRA DR NE, ALBUQUERQUE, NM 87108-1417
(505) 246-6971
(505) 247-2191
Mailing address
2400 MONROE ST NE, ALBUQUERQUE, NM 87110-4063
(505) 246-6971
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
09/01/2021
Last updated
05/13/2024
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