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CASA ANGELICA NPI 1013067974


NPI Information

NPI: 1013067974
Provider Name: CASA ANGELICA
Classification: Intermediate Care Facility, Mentally Retarded - 315P00000X
Entity Type: Organization

CLIA Number: 32D0916190

Address:
5629 ISLETA BLVD SW
ALBUQUERQUE, NM
ZIP 87105
Phone: (505) 877-5763
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CASA ANGELICA is an intermediate care facility mentally retarded in Albuquerque, NM. The provider is (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. CASA ANGELICA NPI is 1013067974. The provider is registered as an organization entity type.

The provider's business location address is:

5629 ISLETA BLVD SW
ALBUQUERQUE, NM
ZIP 87105-623
Phone: (505) 877-5763
Fax: (505) 873-2786

The provider's authorized official is Louise Turner .
The authorized official title is Administrator and has the following contact phone number (505) 877-5763.

The CLIA number assigned to this NPI record is 32D0916190 - intermediate care facility/individuals with intellectual disability with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/11/2007 and was last updated on 7/9/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1315P00000XIntermediate Care Facility, Mentally Retarded5118NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1M-0664MEDICAIDNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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