- Enrollment id
- O20240807002076
- Enrollment state
- NM
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1578344818
- Multiple npi flag
- N
- Ccn
- 325045
- Associate id
- 1052858156
- Organization name
- 369 ALBUQUERQUE OPS LLC
- Doing business as name
- PRINCETON HEALTH AND REHABILITATION
- Incorporation date
- 2023-09-26
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PRINCETON HEALTH & REHABILITATION
- Address line 1
- 500 LOUISIANA BLVD NE
- City
- ALBUQUERQUE
- State
- NM
- Zip code
- 871082051