Provider Demographics
NPI:1124059084
Name:SOUTH VALLEY CARE CENTER, LLC
Entity type:Organization
Organization Name:SOUTH VALLEY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-450-5612
Mailing Address - Street 1:2155 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE 10200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5409
Mailing Address - Country:US
Mailing Address - Phone:505-881-0979
Mailing Address - Fax:505-881-1189
Practice Address - Street 1:1629 BOWE LN SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3772
Practice Address - Country:US
Practice Address - Phone:505-877-2200
Practice Address - Fax:505-877-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAPPLIED FOR313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility