Provider Demographics
NPI:1306072822
Name:PREFERRED ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:PREFERRED ASSISTED LIVING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-884-3830
Mailing Address - Street 1:5500 SAN MATEO BLVD NE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6299
Mailing Address - Country:US
Mailing Address - Phone:505-884-3830
Mailing Address - Fax:505-828-1091
Practice Address - Street 1:5500 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE 114
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6299
Practice Address - Country:US
Practice Address - Phone:505-884-3830
Practice Address - Fax:505-828-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2064310400000X
NM2125310400000X
NM2024310400000X
NM5777310400000X
NM2065310400000X
NM2068310400000X
NM2084310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility