NPIMap

Organization Active NPI

Senior Citizen Resident Center

  • Assisted Living Facility
  • Clovis, NM
National Provider Identifier
1508020975
Registry record updated Jul 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
5539 Issued in NM
Legal business name
SENIOR CITIZEN RESIDENT CENTER
Practice address
2210 Marby Drive
Clovis, NM 88101-8306
Phone
(575) 762-8052
Fax
(575) 769-1553
NPI assigned
Jul 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2011

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

Authorized official

Name
Mrs. Virginia Louise Shonkwiler
Title
Assistant Administrator
Phone
(575) 762-8052

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 5539 NM Primary

Addresses

Primary practice location

2210 Marby Drive
Clovis, NM 88101-8306

Mailing address

2210 Marby Drive
Clovis, NM 88101-8306
Phone (575) 762-8052

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1508020975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 MARBY DRIVE",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881018306",
            "telephone_number": "575-762-8052",
            "fax_number": "575-769-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 MARBY DRIVE",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881018306",
            "telephone_number": "575-762-8052",
            "fax_number": "575-769-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CITIZEN RESIDENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-15",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "SHONKWILER",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "575-762-8052",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NM",
            "license": "5539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; 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.