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General NPI Number Information
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NPI Number | 1437914967
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Entity Type | Organization
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Legal Business Name | CASA DE GRACIA
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 521 PALOMAS DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1625
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Country | US
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Telephone | 505-604-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 521 PALOMAS DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1625
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Country | US
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Telephone | 505-604-2030
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | MR. NICHOLAS STONE
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Credential | MSW
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Telephone | 505-550-1539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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