VILLA GUADALUPE
NPI 1902022130
Assisted Living Facility in Gallup, NM

NPI Status: Active since April 17, 2007

Contact Information

1900 MARK AVE
GALLUP, NM
ZIP 87301
Phone: (505) 863-6894
Fax: (505) 722-4121

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  • Organization
  • Assisted Living Facility
  • CLIA Number: 32D1064469
  • CLIA Cert. Type: Assisted Living Facility
  • CLIA Exp. Date: 02-05-2027

About VILLA GUADALUPE

This page provides the complete NPI Profile along with additional information for Villa Guadalupe, a provider established in Gallup, New Mexico operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1902022130 assigned on April 2007. The practitioner's primary taxonomy code is 310400000X with license number 5119 (NM). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's other name is Villa Guadalupe. The authorized official of this NPI record is Mary Thomas D'mello (Director)

NPI
1902022130
Provider Legal Name
LITTLE SISTERS OF THE POOR OF NEW MEXICO, INC.
Other Organization Name
VILLA GUADALUPE
Other Name Type
Other Name (5)
Entity Type
Organization
Location Address
1900 MARK AVE GALLUP, NM 87301
Location Phone
(505) 863-6894
Location Fax
(505) 722-4121
Mailing Address
1900 MARK AVE GALLUP, NM 87301
Mailing Phone
(505) 863-6894
Mailing Fax
(505) 722-4121
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
04-17-2007
Last Update Date
08-22-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
License No.
5119
License State
NM
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MARY THOMAS D'MELLO

Authorized Official Title
DIRECTOR
Authorized Official Phone
(505) 863-6894

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
5119OTHER (01)NMARC LICENSE #

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
32D1064469
Facility Type
Assisted Living Facility
Certificate Effective Date
February 06, 2025
Certificate Expiration Date
February 05, 2027
Laboratory Director
SR THERESA LOUISA WOO CHING
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Villa Guadalupe to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1902022130
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
290202416
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 9 + 0 + 2 + 0 + 2 + 4 + 1 + 6 + 24 = 50
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1902022130 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER

Assisted Living Facility

1900 MARK AVE
GALLUP, NM
ZIP 87301

(505) 722-1000

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1902022130, enumerated as an "organization" on April 17, 2007.

The provider is located at 1900 MARK AVE GALLUP, NM 87301 and the phone number is (505) 863-6894.

Assisted Living Facility with taxonomy code 310400000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.