Provider Demographics
NPI:1942247598
Name:LEA REGIONAL HOSPITAL LLC
Entity Type:Organization
Organization Name:LEA REGIONAL HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:PO BOX 848156
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8156
Mailing Address - Country:US
Mailing Address - Phone:505-492-5000
Mailing Address - Fax:505-492-5505
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9100
Practice Address - Country:US
Practice Address - Phone:505-492-5000
Practice Address - Fax:505-492-5505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEA REGIONAL HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6745273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB3139Medicaid
NMB3139Medicaid