Casa del Valle 1

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5280 Issued in NM

Legal business name

CASA DEL VALLE 1

Practice address

2111 Raven LN SW
Albuquerque, NM 87105-4530

Phone

(505) 877-0275

Fax

(505) 877-1249

NPI assigned

Jan 16, 2015

Last updated

May 13, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gary Lee SandovalNPI 1922786763

Title

Administrator

Phone

(505) 877-0275

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary Lee Sandoval

  • PACE Provider Organization
  • Albuquerque, NM
  • NPI 1922786763
  NPD Authorized official

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

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1295124022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 RAVEN LN SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871054530",
            "telephone_number": "505-877-0275",
            "fax_number": "505-877-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 RAVEN LN SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871054530",
            "telephone_number": "505-877-0275",
            "fax_number": "505-877-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASA DEL VALLE 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-16",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "505-877-0275",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NM",
            "license": "5280",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Assisted Living Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.