Provider Demographics
NPI:1750511986
Name:SU CASA HEALTH CARE SERVICES OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:SU CASA HEALTH CARE SERVICES OF NEW MEXICO LLC
Other - Org Name:SU CASA HEALTH CARE OF NEW MEXICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:432-553-0279
Mailing Address - Street 1:5290 MCNUTT RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9648
Mailing Address - Country:US
Mailing Address - Phone:575-589-0819
Mailing Address - Fax:575-589-1476
Practice Address - Street 1:5290 MCNUTT RD
Practice Address - Street 2:STE. 105
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9645
Practice Address - Country:US
Practice Address - Phone:575-589-0819
Practice Address - Fax:575-589-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health