Provider Demographics
NPI:1124702246
Name:SAN JUAN CARE CENTER LLC
Entity type:Organization
Organization Name:SAN JUAN CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-987-5954
Mailing Address - Street 1:806 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5631
Mailing Address - Country:US
Mailing Address - Phone:505-325-2910
Mailing Address - Fax:505-325-0191
Practice Address - Street 1:806 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5631
Practice Address - Country:US
Practice Address - Phone:505-325-2910
Practice Address - Fax:505-325-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility