MEDICARE: CASA FORTALEZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	I05918	NM

General Provider Information

NPI Number	:	1225499296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA FORTALEZA

Provider Business Mailing Address
First Line	:	PO BOX 36594
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87176-6594
Country	:	US
Telephone Number	:	505-485-4826
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 ALAMO AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3234
Country	:	US
Telephone Number	:	505-485-4826
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH WOLFF FRANCIS
Credential	:	LISW
Telephone Number	:	505-485-4826

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	03/17/2016

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Directions to “CASA FORTALEZA ” Practice Location

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