Healthcare Provider Details

I. General information

NPI: 1902975436
Provider Name (Legal Business Name): LIFECARE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SIRINGO RD SUITE 201
SANTA FE NM
87505-5863
US

IV. Provider business mailing address

130 SIRINGO RD SUITE 201
SANTA FE NM
87505-5863
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-3236
  • Fax: 505-989-5079
Mailing address:
  • Phone: 505-989-3236
  • Fax: 505-989-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR27286
License Number StateNM

VIII. Authorized Official

Name: MRS. F. ELAINE MONTANO
Title or Position: OWNER
Credential: CNP
Phone: 505-989-3236