32D0916190 CLIA NUMBER - CASA ANGELICA

Laboratory Demographics

CLIA Number: 32D0916190

Facility Name: CASA ANGELICA

Facility Address:
5629 ISLETA BOULEVARD SW
ALBUQUERQUE, NM
ZIP 87105
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Facility Phone Number: 505 877-5763

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1013067974

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	32D0916190
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	CASA ANGELICA
Street	5629 ISLETA BOULEVARD SW
City	ALBUQUERQUE
State	NM
ZIP	87105
Phone	505 877-5763
CertificateType	4
CertificateEffectiveDate	6/17/2022
CertificateExpirationDate	6/16/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024