Provider Demographics
NPI:1033593082
Name:LA CASA DE BUENA SALUD INC
Entity Type:Organization
Organization Name:LA CASA DE BUENA SALUD INC
Other - Org Name:LA CASA SCHOOL BASED MEDICAL/DENTAL CENTER-MESA MIDDLE SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEFERINO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-356-6695
Mailing Address - Street 1:1515 W FIR ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-5703
Mailing Address - Country:US
Mailing Address - Phone:575-356-6695
Mailing Address - Fax:
Practice Address - Street 1:1601 E BLAND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-7900
Practice Address - Country:US
Practice Address - Phone:575-627-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)