Basic Information
| Provider Information | |||||||||
| NPI: | 1013963081 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SILVERSTONE HEALTHCARE OF OF RATON, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RATON NURSING & REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SUN AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054685604 | ||||||||
| FaxNumber: | 5054684681 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | RATON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 877402022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054452734 | ||||||||
| FaxNumber: | 5054458451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MATHIES | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5058213355 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1029 | NM | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 56203292 | 05 | NM | MEDICAID |