NPIMap

Organization Active NPI

Great Livin II LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Albuquerque, NM
National Provider Identifier
1750947420
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
GREAT LIVIN II LLC
Practice address
4028 Mescalero Rd NE
Albuquerque, NM 87110-1754
Phone
(505) 246-6971
Fax
(505) 247-2191
NPI assigned
May 17, 2019
Last updated
May 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GREAT LIVIN II LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Authorized official

Name
Matt Poel
Title
Owner
Phone
(505) 246-6971

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

4028 Mescalero Rd NE
Albuquerque, NM 87110-1754

Mailing address

2400 Monroe St NE
Albuquerque, NM 87110-4063
Phone (505) 246-6971

Other practice location 1

2901 Juan Tabo Blvd NE Ste 208
Albuquerque, NM 87112-1885
Phone (505) 246-6971

Other practice location 2

2400 Monroe St NE
Albuquerque, NM 87110-4063
Phone (505) 246-6971

Other identifiers 1

IdentifierTypeStateIssuer
49852591MedicaidNM

Other names 1

  • Great Livin II Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Great Livin II LLC3 organizations share this tax ID, including this one
Part of
Great Livin II LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2400 Monroe St NE
Albuquerque, NM 87110
Phone (505) 246-6971

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1750947420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MONROE ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871104063",
            "telephone_number": "505-246-6971",
            "fax_number": "505-247-2191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4028 MESCALERO RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101754",
            "telephone_number": "505-246-6971",
            "fax_number": "505-247-2191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 Juan Tabo Blvd NE Ste 208",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871121885",
            "country_code": "US",
            "telephone_number": "505-246-6971",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 Monroe St NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871104063",
            "country_code": "US",
            "telephone_number": "505-246-6971",
            "fax_number": "505-247-2191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT LIVIN II LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LIVIN II  LLC",
        "enumeration_date": "2019-05-17",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "POEL",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-246-6971"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49852591",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Livin II",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Great Livin II",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • 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.