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Organization
CASA MESITA GROUP HOME, INC
Active
Organization
CASA MESITA GROUP HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL BARTHOLOMEW (PRESIDENT, BOARD OF DIRECTORS)
(505) 662-4378
Entity
Organization
Contact information
Practice address
4007 SYCAMORE ST, LOS ALAMOS, NM 87544-1728
(505) 662-4378
(505) 662-6834
Mailing address
4007 SYCAMORE ST, LOS ALAMOS, NM 87544-1728
(505) 662-4378
(505) 662-6834
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
4119
NM
Other
Enumeration date
01/22/2009
Last updated
01/22/2009
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