Provider Demographics
NPI:1043580533
Name:MI CASA HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MI CASA HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GURULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-205-1047
Mailing Address - Street 1:9301 INDIAN SCHOOL RD NE
Mailing Address - Street 2:SUITE 208-C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2884
Mailing Address - Country:US
Mailing Address - Phone:505-205-1047
Mailing Address - Fax:505-962-2341
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 208-C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2884
Practice Address - Country:US
Practice Address - Phone:505-205-1047
Practice Address - Fax:505-962-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health