MEDICARE: CASA REAL NURSING OPERATIONS 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	314000000X	Skilled Nursing Facility	1055	NM

General Provider Information

NPI Number	:	1780883298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA REAL NURSING OPERATIONS LLC

Provider Business Mailing Address
First Line	:	306 W 7TH ST STE 415
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4905
Country	:	US
Telephone Number	:
Fax Number	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENT HARRINGTON
Credential	:
Telephone Number	:	817-335-4111

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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