Provider Demographics
NPI:1215061684
Name:ATRISCO LIGHTS LLC
Entity type:Organization
Organization Name:ATRISCO LIGHTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:PFEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-890-8187
Mailing Address - Street 1:6300 MONTANO RD NW
Mailing Address - Street 2:SUITE A 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2151
Mailing Address - Country:US
Mailing Address - Phone:505-890-8187
Mailing Address - Fax:505-899-8736
Practice Address - Street 1:1430 ATRISCO DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1110
Practice Address - Country:US
Practice Address - Phone:505-890-8187
Practice Address - Fax:505-899-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5264310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA0975Medicaid