Basic Information
| Provider Information | |||||||||
| NPI: | 1700042439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOVELACE HEALTH SYSTEMS LLC | ||||||||
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| OtherOrganizationName: | LOVELACE REHABILITATION HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 ELM ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057274700 | ||||||||
| FaxNumber: | 5057279404 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 ELM ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057274700 | ||||||||
| FaxNumber: | 5057279404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2008 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | PETROVICH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP | ||||||||
| AuthorizedOfficialTelephone: | 6152963000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARDENT LEGACY HOLDINGS, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 3140 | NM | Y | Hospitals | Rehabilitation Hospital |
No ID Information.