NPIMap

Organization Active NPI

La Casa de Buena Salud Inc

Doing business as La Casa Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Roswell, NM
National Provider Identifier
1215037379
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CASA DE BUENA SALUD INC
Doing business as
La Casa Family Health Center
Practice address
1511 South Grand Avenue
Roswell, NM 88201
Phone
(505) 623-3255
Fax
(505) 625-9901
NPI assigned
Sep 25, 2006
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
LA CASA DE BUENA SALUD INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Seferino M Montano
Title
Ceo
Phone
(505) 356-6695

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6460 NM
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1511 South Grand Avenue
Roswell, NM 88201

Mailing address

PO Box 843
Portales, NM 88130
Phone (505) 356-6695

Other practice location 1

75 University Blvd
Ste 130
Roswell, NM 88203
Phone (575) 624-7207

Other identifiers 1

IdentifierTypeStateIssuer
70275MedicaidNM

Other names 1

  • La Casa Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100924000253 NM Part A Provider - Federally Qualified Health Center (FQHC) 9234032939 Practice locations: Roswell, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215037379. Details of each certification follow.

Federally qualified health center certification: CCN 321857

Legal name
LA CASA DE BUENA SALUD INC
Doing business as
LA CASA FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 20, 1994
Last certification
Sep 20, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1974 in NM
Enrollment address
1511 S Grand Ave
Roswell, NM 88203-5407
Related CCNs
321802

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D0920634La Casa de Buena Salud Inc1511 S Grand, Roswell, NM 88203Provider-performed microscopyApr 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mark H Bayliss PA14 organizations share this tax ID, including this one
Part of
Mark H Bayliss PA

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joe Strickland Individual Corporate DirectorBoard Member Jan 1, 2019
Jose Mendoza Individual Corporate DirectorBoard Member Jan 1, 2017
Jorge Rodriguez Individual Corporate DirectorBoard Member Jan 26, 2022
Douglas R Thornton Individual Corporate OfficerCfo Apr 1, 2020
Kern Anderson Individual Corporate DirectorBoard Member Oct 1, 2015
Isabell Walla Individual Corporate Director Jul 19, 2010
Lisa Jaynes Individual Corporate DirectorBoard Member Jan 24, 2018
Teresa Welch Individual Corporate Director Jan 23, 2019
Katherine McClain Individual Corporate DirectorBoard Member Jan 26, 2022
Carmen Pacheco-Munoz Individual Corporate Officer Nov 14, 2014
Seferino Montano Individual Corporate OfficerCeo Dec 2, 2008
W-2 Managing EmployeeCeo Dec 2, 2008
Veronica Cordova Individual Corporate DirectorBoard Member Jan 24, 2018
Warren a Yehl Individual Corporate DirectorBoard Member Jan 26, 2022
Eddie Carrillo Individual Corporate DirectorBoard Member Jan 26, 2022

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1215037379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "88130",
            "telephone_number": "505-356-6695",
            "fax_number": "505-356-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 SOUTH GRAND AVENUE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "88201",
            "telephone_number": "505-623-3255",
            "fax_number": "505-625-9901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 University Blvd",
            "address_2": "Ste 130",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "88203",
            "country_code": "US",
            "telephone_number": "575-624-7207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LA CASA DE BUENA SALUD INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LA CASA DE BUENA SALUD INC",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "MONTANO",
        "authorized_official_first_name": "SEFERINO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-356-6695"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6460",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70275",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Casa Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Casa Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, NM

Sources for this page

Verify at the official NPI Registry.