Organization
RUSTIC HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J DONAVAN LPN (OWNER/ADMINISTRATOR)
(575) 479-7773
Entity
Organization
Contact information
Practice address
405 N DATE ST STE 4, T OR C, NM 87901-2378
(575) 297-4993
(575) 205-0274
Mailing address
1301 CUBA AVE, ALAMOGORDO, NM 88310-5727
(575) 479-7773
(575) 205-0274
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
12/16/2022
Last updated
03/31/2026
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