803 Hacienda Lane Operations LLC
NPI #1134607690 in Bloomfield, New Mexico
Provider Information
- NPI Number
- 1134607690
- Entity Type
- Organization
- Organization Name
- 803 Hacienda Lane Operations LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Aug 6, 2018
- Last Updated
- Aug 6, 2018
Practice Location
- Address
- 803 HACIENDA LN
- City
- Bloomfield
- State
- New Mexico
- ZIP Code
- 87413-5109
- Phone
- (610) 925-2254
Authorized Official
- Name
- MICHAEL BERG
- Title
- ASSISTANT SECRETARY
- Phone
- (610) 925-2254
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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