MEDICARE: CASITA SENIOR LIVING, LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1578144655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASITA SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11962
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87192-0962
Country	:	US
Telephone Number	:	505-308-3058
Fax Number	:

Provider Business Practice Location Address
First Line	:	5141 GEORGIA PL NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-6483
Country	:	US
Telephone Number	:	505-308-3058
Fax Number	:

Authorized Official
Title or Position	:	NURSE
Name	:	MONICA LOVATO
Credential	:	REGISTERED NURSE
Telephone Number	:	505-366-4398

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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