Healthcare Provider Details

I. General information

NPI: 1487563516
Provider Name (Legal Business Name): MI CASA SAGRADA LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 VISTA CUESTA
LAS CRUCES NM
88001-7505
US

IV. Provider business mailing address

4895 VISTA CUESTA
LAS CRUCES NM
88001-7505
US

V. Phone/Fax

Practice location:
  • Phone: 915-490-7094
  • Fax: 575-649-4038
Mailing address:
  • Phone: 915-490-7094
  • Fax: 575-649-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TERESA SOTO
Title or Position: CO-OWNER
Credential:
Phone: 915-490-7094