Healthcare Provider Details

I. General information

NPI: 1194328591
Provider Name (Legal Business Name): CASA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 SAN VICENTE AVE NE
ALBUQUERQUE NM
87109-2766
US

IV. Provider business mailing address

PO BOX 92050
ALBUQUERQUE NM
87199-2050
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-8202
  • Fax: 505-226-0896
Mailing address:
  • Phone: 505-226-8202
  • Fax: 505-226-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: GARY SANCHEZ
Title or Position: OWNER
Credential:
Phone: 505-226-8202