MEDICARE: CASITA HOME HEALTH 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770283418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASITA HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	848 CAMINO VISTA RIO
Second Line	:
City	:	BERNALILLO
State	:	NM
Zip	:	87004-6098
Country	:	US
Telephone Number	:	505-730-5550
Fax Number	:	505-465-9111

Provider Business Practice Location Address
First Line	:	5141 GEORGIA PL NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-6483
Country	:	US
Telephone Number	:	505-610-6512
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN JAMES CAUDILL
Credential	:
Telephone Number	:	505-730-5550

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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