Provider Demographics
NPI:1528259124
Name:LA CASA FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:LA CASA FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-769-0888
Mailing Address - Street 1:1521 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5568
Mailing Address - Country:US
Mailing Address - Phone:505-769-0227
Mailing Address - Fax:505-763-9154
Practice Address - Street 1:1521 W 13TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5568
Practice Address - Country:US
Practice Address - Phone:505-769-0227
Practice Address - Fax:505-763-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000018773336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy