Provider Demographics
NPI:1205957487
Name:LA CASA DE BUENA SALUD INC
Entity type:Organization
Organization Name:LA CASA DE BUENA SALUD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEFERINO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-356-6695
Mailing Address - Street 1:103 DON PABLO LANE
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:NM
Mailing Address - Zip Code:88336
Mailing Address - Country:US
Mailing Address - Phone:505-653-4830
Mailing Address - Fax:505-653-4833
Practice Address - Street 1:103 DON PABLO LANE
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:NM
Practice Address - Zip Code:88336
Practice Address - Country:US
Practice Address - Phone:505-653-4830
Practice Address - Fax:505-653-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)