MEDICARE: SF HEALTH FACILITIES - CASA REAL LP

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	314000000X	Skilled Nursing Facility	1088	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487907820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SF HEALTH FACILITIES - CASA REAL LP

Provider Business Mailing Address
First Line	:	5420 W PLANO PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4823
Country	:	US
Telephone Number	:	972-931-3800
Fax Number	:	972-767-6222

Provider Business Practice Location Address
First Line	:	1650 GALISTEO ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4747
Country	:	US
Telephone Number	:	505-984-8313
Fax Number	:	505-984-2542

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MRS. JAMIE L COLLIER
Credential	:
Telephone Number	:	972-931-3800

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	08/19/2015

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