Healthcare Provider Details

I. General information

NPI: 1770283418
Provider Name (Legal Business Name): CASITA HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 GEORGIA PL NE
RIO RANCHO NM
87144-6483
US

IV. Provider business mailing address

848 CAMINO VISTA RIO
BERNALILLO NM
87004-6098
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-6512
  • Fax:
Mailing address:
  • Phone: 505-730-5550
  • Fax: 505-465-9111

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: KEVIN JAMES CAUDILL
Title or Position: OWNER
Credential:
Phone: 505-730-5550