Provider Demographics
NPI:1063809085
Name:RIO SEDILLO ASSISTED LIVING
Entity type:Organization
Organization Name:RIO SEDILLO ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:505-261-7380
Mailing Address - Street 1:133 CAMINO LOS CHAVEZ
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031
Mailing Address - Country:US
Mailing Address - Phone:505-261-7380
Mailing Address - Fax:
Practice Address - Street 1:133 CAMINO, LOS CHAVEZ
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-440-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2270305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMO3029929000OtherWE HAVE NOT RECEIVED ANY ISSUED NO'S YET,WE ARE DOING MADD FOR MEDICARE