Healthcare Provider Details

I. General information

NPI: 1750009627
Provider Name (Legal Business Name): LA CASA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S WALNUT ST
LAS CRUCES NM
88001-3954
US

IV. Provider business mailing address

800 S WALNUT ST
LAS CRUCES NM
88001-3954
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-2819
  • Fax: 575-526-8542
Mailing address:
  • Phone: 575-526-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KERI NUNEZ
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 575-526-2819