Provider Demographics
NPI:1033698055
Name:CASA SHALOM
Entity Type:Organization
Organization Name:CASA SHALOM
Other - Org Name:CASA SHALOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:0WNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-307-4944
Mailing Address - Street 1:11189 PADUCAH AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1112
Mailing Address - Country:US
Mailing Address - Phone:915-875-2142
Mailing Address - Fax:
Practice Address - Street 1:6519 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2112
Practice Address - Country:US
Practice Address - Phone:915-875-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home