Healthcare Provider Details

I. General information

NPI: 1053201194
Provider Name (Legal Business Name): LOVE OF ROSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 TUSCAN RIDGE CIR
SANTA TERESA NM
88008-9808
US

IV. Provider business mailing address

104 TUSCAN RIDGE CIR
SANTA TERESA NM
88008-9808
US

V. Phone/Fax

Practice location:
  • Phone: 575-936-0398
  • Fax:
Mailing address:
  • Phone: 575-936-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ARLEAN MURILLO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-936-0398