Healthcare Provider Details

I. General information

NPI: 1740769272
Provider Name (Legal Business Name): LOVINGTON CARE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE I
LOVINGTON NM
88260-5002
US

IV. Provider business mailing address

5200 N PALM AVE STE 107
FRESNO CA
93704-2225
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-5212
  • Fax:
Mailing address:
  • Phone: 888-725-9186
  • Fax: 559-667-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNM

VIII. Authorized Official

Name: BRANDON BIGELOW
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 888-725-9186