Provider Demographics
NPI:1275100471
Name:CASA BLANCA, LLC
Entity Type:Organization
Organization Name:CASA BLANCA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SANTOS-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-422-1968
Mailing Address - Street 1:8913 MCFALL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5135
Mailing Address - Country:US
Mailing Address - Phone:915-422-1968
Mailing Address - Fax:
Practice Address - Street 1:224 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9366
Practice Address - Country:US
Practice Address - Phone:915-422-1968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health