Provider Demographics
NPI:1528102845
Name:THE ARISTOCRAT OF LAS CRUCES, LLC
Entity type:Organization
Organization Name:THE ARISTOCRAT OF LAS CRUCES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-521-3326
Mailing Address - Street 1:800 N TELSHOR BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8251
Mailing Address - Country:US
Mailing Address - Phone:505-521-3326
Mailing Address - Fax:505-521-4772
Practice Address - Street 1:1111 E MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2746
Practice Address - Country:US
Practice Address - Phone:505-527-2795
Practice Address - Fax:505-521-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5772310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA0520Medicaid