Healthcare Provider Details

I. General information

NPI: 1700042439
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 05/29/2019
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: 505-727-4700
  • Fax: 505-727-9404
Mailing address:
  • Phone: 505-727-4700
  • Fax: 505-727-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number3140
License Number StateNM

VIII. Authorized Official

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