Healthcare Provider Details

I. General information

NPI: 1114131836
Provider Name (Legal Business Name): CASA DE CARINO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 INDIAN FARM LN NW
ALBUQUERQUE NM
87107-2640
US

IV. Provider business mailing address

2908 INDIAN FARM LN NW
ALBUQUERQUE NM
87107-2640
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-4203
  • Fax: 505-345-4206
Mailing address:
  • Phone: 505-345-4203
  • Fax: 505-345-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: TERESA E. GARCIA
Title or Position: OWNER / RN
Credential:
Phone: 505-363-4735