MEDICARE: MI CASA P.A.S., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	009548	TX

General Provider Information

NPI Number	:	1073739447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI CASA P.A.S., INC

Provider Business Mailing Address
First Line	:	PO BOX 1136
Second Line	:
City	:	CLINT
State	:	TX
Zip	:	79836-1136
Country	:	US
Telephone Number	:	915-851-4663
Fax Number	:	915-851-0899

Provider Business Practice Location Address
First Line	:	440 FM 1110
Second Line	:
City	:	SAN ELIZARIO
State	:	TX
Zip	:	79849
Country	:	US
Telephone Number	:	915-851-4663
Fax Number	:	915-851-0899

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MANUEL HECTOR GONZALEZ SR.
Credential	:
Telephone Number	:	915-851-4663

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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