Basic Information
| Provider Information | |||||||||
| NPI: | 1275100471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASA BLANCA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8913 MCFALL DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799255135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154221968 | ||||||||
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| Practice Location | |||||||||
| Address1: | 224 ANTHONY DR | ||||||||
| Address2: | |||||||||
| City: | ANTHONY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880219366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154221968 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2021 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | SANTOS-RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CO OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9154221968 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.