Great Livin', LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

86879375 Issued in NM

Legal business name

GREAT LIVIN', LLC

Practice address

4213 Ponderosa Ave NE
Albuquerque, NM 87110-1031

Phone

(505) 620-3849

NPI assigned

May 2, 2008

Last updated

May 2, 2008By 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. Matt Poel

Title

Executive Director

Phone

(505) 620-3849

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209686400000",
    "number": "1902072697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 PONDEROSA AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4213 PONDEROSA AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101031",
            "telephone_number": "505-620-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LIVIN', LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-02",
        "last_updated": "2008-05-02",
        "status": "A",
        "authorized_official_last_name": "POEL",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "505-620-3849",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NM",
            "license": "86879375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86879375",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Grazda, DPT
• Rachel Grazda
• Great Livin II LLC
• Great Livin II LLC
• Great Livin II LLC
• Great White Dentistry (Isham Dental)
• Jacob Greaves, DDS
• William H Greaves, SW
• Mary L. Grebenc, M.D.
• Laurelai Greces Sierra

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; 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.