Healthcare Provider Details

I. General information

NPI: 1548474141
Provider Name (Legal Business Name): NEW HORIZONS CASA LINDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 AVENUE E
CARRIZOZO NM
88301-0187
US

IV. Provider business mailing address

PO BOX 187
CARRIZOZO NM
88301-0187
US

V. Phone/Fax

Practice location:
  • Phone: 505-648-2379
  • Fax:
Mailing address:
  • Phone: 505-648-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number5086
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number5086
License Number StateNM

VIII. Authorized Official

Name: MS. JENNY KELLY
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 505-648-2379