Healthcare Provider Details

I. General information

NPI: 1437914967
Provider Name (Legal Business Name): CASA DE GRACIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PALOMAS DR NE
ALBUQUERQUE NM
87108-1625
US

IV. Provider business mailing address

521 PALOMAS DR NE
ALBUQUERQUE NM
87108-1625
US

V. Phone/Fax

Practice location:
  • Phone: 505-604-2030
  • Fax:
Mailing address:
  • Phone: 505-604-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS STONE
Title or Position: C.E.O
Credential: MSW
Phone: 505-550-1539