Atrisco Lights LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5264 Issued in NM

Legal business name

ATRISCO LIGHTS LLC

Practice address

1430 Atrisco Dr NW
Albuquerque, NM 87105-1110

Phone

(505) 890-8187

Fax

(505) 899-8736

NPI assigned

Mar 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Mary Pfeifer, RN

Title

Owner Member

Phone

(505) 890-8187

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215061684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 MONTANO RD NW",
            "address_2": "SUITE A 2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871202151",
            "telephone_number": "505-890-8187",
            "fax_number": "505-899-8736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 ATRISCO DR NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871051110",
            "telephone_number": "505-890-8187",
            "fax_number": "505-899-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATRISCO LIGHTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PFEIFER",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "OWNER MEMBER",
        "authorized_official_telephone_number": "505-890-8187",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NM",
            "license": "5264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A0975",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.