3720 Church Rock Street Operations LLC
NPI #1356820419 in Gallup, New Mexico
Provider Information
- NPI Number
- 1356820419
- Entity Type
- Organization
- Organization Name
- 3720 Church Rock Street Operations LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Aug 9, 2018
- Last Updated
- Aug 9, 2018
Practice Location
- Address
- 3720 CHURCH ROCK ST
- City
- Gallup
- State
- New Mexico
- ZIP Code
- 87301-4572
- Phone
- (505) 722-2261
Authorized Official
- Name
- MICHAEL BERG
- Title
- ASSISTANT SECRETARY
- Phone
- (505) 468-4742
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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