Healthcare Provider Details

I. General information

NPI: 1275100471
Provider Name (Legal Business Name): CASA BLANCA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ANTHONY DR
ANTHONY NM
88021-9366
US

IV. Provider business mailing address

8913 MCFALL DR
EL PASO TX
79925-5135
US

V. Phone/Fax

Practice location:
  • Phone: 915-422-1968
  • Fax:
Mailing address:
  • Phone: 915-422-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SANDRA MICHELLE SANTOS-RODRIGUEZ
Title or Position: CO OWNER
Credential:
Phone: 915-422-1968