Provider Demographics
NPI:1548015217
Name:RUSTIC HEALTH LLC
Entity type:Organization
Organization Name:RUSTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DONAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:575-479-7773
Mailing Address - Street 1:1301 CUBA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5727
Mailing Address - Country:US
Mailing Address - Phone:575-479-7773
Mailing Address - Fax:575-205-0274
Practice Address - Street 1:1301 CUBA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5727
Practice Address - Country:US
Practice Address - Phone:575-479-7773
Practice Address - Fax:575-205-0274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1215649629
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-17
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No385H00000XRespite Care FacilityRespite Care