Healthcare Provider Details

I. General information

NPI: 1528259124
Provider Name (Legal Business Name): LA CASA FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 W 13TH ST
CLOVIS NM
88101-5568
US

IV. Provider business mailing address

1521 W 13TH ST
CLOVIS NM
88101-5568
US

V. Phone/Fax

Practice location:
  • Phone: 505-769-0227
  • Fax: 505-763-9154
Mailing address:
  • Phone: 505-769-0227
  • Fax: 505-763-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH00001877
License Number StateNM

VIII. Authorized Official

Name: MRS. MELISSA C. RAINS
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential: RPH
Phone: 505-769-0888