Healthcare Provider Details

I. General information

NPI: 1053488494
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ELM ST NE
ALBUQUERQUE NM
87102-2500
US

IV. Provider business mailing address

505 ELM ST NE
ALBUQUERQUE NM
87102-2500
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN PETROVICH
Title or Position: SVP
Credential:
Phone: 615-296-3000