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General NPI Number Information
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NPI Number | 1750511986
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Entity Type | Organization
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Legal Business Name | SU CASA HEALTH CARE SERVICES OF NEW MEXICO LLC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 5290 MCNUTT RD STE. 105
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City | SANTA TERESA
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State | NM
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Zip | 88008-9645
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Country | US
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Telephone | 575-589-0819
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Fax | 575-589-1476
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Provider Business Mailing Address
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Address Line | 5290 MCNUTT RD STE 105
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City | SUNLAND PARK
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State | NM
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Zip | 88008-9648
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Country | US
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Telephone | 575-589-0819
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Fax | 575-589-1476
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELVA BROWN
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Credential | RN
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Telephone | 432-553-0279
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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 | NM
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