Provider Demographics
NPI:1275174740
Name:CASA DE MI ALMA INC
Entity Type:Organization
Organization Name:CASA DE MI ALMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA O
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-993-8143
Mailing Address - Street 1:920 N ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2291
Mailing Address - Country:US
Mailing Address - Phone:575-993-8143
Mailing Address - Fax:
Practice Address - Street 1:920 N ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2291
Practice Address - Country:US
Practice Address - Phone:575-993-8143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03-429284-00-5Medicaid