Provider Demographics
NPI:1265505606
Name:LIFE MANAGEMENT CENTER
Entity Type:Organization
Organization Name:LIFE MANAGEMENT CENTER
Other - Org Name:EL PASO MHMR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-887-3410
Mailing Address - Street 1:1600 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5622
Mailing Address - Country:US
Mailing Address - Phone:915-887-3410
Mailing Address - Fax:915-783-6550
Practice Address - Street 1:9555 DIANA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6951
Practice Address - Country:US
Practice Address - Phone:915-747-3580
Practice Address - Fax:915-759-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645710261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health