Provider Demographics
NPI:1093497851
Name:LIFECARE MOUNTAIN HOSPICE, LLC
Entity Type:Organization
Organization Name:LIFECARE MOUNTAIN HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-451-5090
Mailing Address - Street 1:PO BOX 733707
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3707
Mailing Address - Country:US
Mailing Address - Phone:806-451-5090
Mailing Address - Fax:469-331-0387
Practice Address - Street 1:1150 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 215
Practice Address - City:SANTE FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:505-633-6683
Practice Address - Fax:505-633-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based