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Organization

LA CASA DE BUENA SALUD INC

Active
Parent organization
LA CASA DE BUENA SALUD INC
Other names
La Casa Family Health Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
LA CASA DE BUENA SALUD INC
Authorized official
SEFERINO MONTANO (CEO)
(505) 356-6695
Entity
Organization

Contact information

Practice address
1521 WEST 13TH STREET, CLOVIS, NM 88101
(505) 769-0888
(505) 763-9154
Mailing address
PO BOX 843, PORTALES, NM 88130
(505) 356-6695
(505) 356-5948

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
6415
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
46976
NM
Enumeration date
09/25/2006
Last updated
03/12/2008
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