Provider Demographics
NPI:1760513741
Name:CASACONNECT, LLC
Entity Type:Organization
Organization Name:CASACONNECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCM, CNLCP
Authorized Official - Phone:505-899-5276
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-1292
Mailing Address - Country:US
Mailing Address - Phone:505-899-5276
Mailing Address - Fax:505-898-1033
Practice Address - Street 1:3918 VILLA WAY SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1047
Practice Address - Country:US
Practice Address - Phone:505-899-5276
Practice Address - Fax:505-898-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30028311Medicaid