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NPI Code Detail

MEDICARE: CASA DE SHALOM, LLC

MEDICARE: CASA DE SHALOM, LLC
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
1251G00000XCommunity Based Hospice Care Agency1T3408NM

General Provider Information

NPI Number : 1740536283
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASA DE SHALOM, LLC
Provider Business Mailing Address
First Line : 4102 LAS CIMBRAS CT SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-6908
Country : US
Telephone Number : 505-715-9649
Fax Number : 505-994-9430
Provider Business Practice Location Address
First Line : 4102 LAS CIMBRAS CT SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-6908
Country : US
Telephone Number : 505-715-9649
Fax Number : 505-994-9430
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. ADAM STANLEY
Credential :
Telephone Number : 505-715-9649
Provider Enumeration Date : 08/02/2012
Last Update Date : 08/02/2012

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