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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000M0196
—
NM
Enumeration date
01/22/2009
Last updated
01/22/2009
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