Provider Demographics
NPI:1902975436
Name:LIFECARE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LIFECARE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:F.
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-989-3236
Mailing Address - Street 1:130 SIRINGO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5863
Mailing Address - Country:US
Mailing Address - Phone:505-989-3236
Mailing Address - Fax:505-989-5079
Practice Address - Street 1:130 SIRINGO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5863
Practice Address - Country:US
Practice Address - Phone:505-989-3236
Practice Address - Fax:505-989-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR27286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48728527Medicaid
NM1679553457OtherPERSONAL NPI
NM48728527Medicaid