Healthcare Provider Details

I. General information

NPI: 1760513741
Provider Name (Legal Business Name): CASACONNECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 VILLA WAY SE
RIO RANCHO NM
87124-1047
US

IV. Provider business mailing address

PO BOX 1292
CORRALES NM
87048-1292
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-5276
  • Fax: 505-898-1033
Mailing address:
  • Phone: 505-899-5276
  • Fax: 505-898-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JOLENE CUNNINGHAM
Title or Position: PRESIDENT
Credential: RN, CCM, CNLCP
Phone: 505-899-5276