Organization
LA CASA DE BUENA SALUD INC
Active
Other names
La Casa Dental School Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SEFERINO MONTANO (CEO)
(575) 356-6695
Entity
Organization
Contact information
Practice address
400 LOCKWOOD DRIVE, CLOVIS, NM 88101-8445
(575) 769-5021
(575) 763-9154
Mailing address
PO BOX 843, PORTALES, NM 88130-0843
(575) 356-6695
(575) 356-5948
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
01/31/2011
Last updated
01/31/2011
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