Organization
RUSTIC HEALTH LLC
Active
Parent organization
1215649629
Organization subpart
Yes
Provider details
NPI number
Legal business name
1215649629
Authorized official
MR. DAVID JOHN DONAVAN LPN (OWNER)
(575) 479-7773
Entity
Organization
Contact information
Practice address
1301 CUBA AVE, ALAMOGORDO, NM 88310-5727
(575) 479-7773
(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
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QP2300X
Primary Care Clinic/Center
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
04/17/2024
Last updated
03/13/2025
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