NPIMap

Organization Active NPI

La Casa de Buena Salud Inc

Doing business as La Casa School Based Clinic

  • Federally Qualified Health Center (FQHC)
  • Clovis, NM
National Provider Identifier
1760788137
Registry record updated Mar 29, 2018
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 School Based Clinic
Practice address
100 Commerce Way
Clovis, NM 88101-4768
Phone
(575) 769-4410
Fax
(575) 763-9154
NPI assigned
Feb 2, 2011
Last updated
Mar 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2018

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

Authorized official

Name
Seferino Montano
Title
Ceo
Phone
(575) 356-6695

Specialties & licenses 1

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

Addresses

Primary practice location

100 Commerce Way
Clovis, NM 88101-4768

Mailing address

PO Box 843
Portales, NM 88130-0843
Phone (575) 356-6695

Other names 1

  • La Casa School Based Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180906000487 NM Part A Provider - Federally Qualified Health Center (FQHC) 9234032939 Practice locations: Clovis, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760788137. Details of each certification follow.

Federally qualified health center certification: CCN 321963

Legal name
LA CASA DE BUENA SALUD INC
Doing business as
LA CASA SCHOOL BASED HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 11, 2018
Last certification
Sep 11, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1974 in NM
Enrollment address
100 Commerce Way
Clovis, NM 88101-4768

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

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

Other organizations with this tax ID 13

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

View all 13

Locations

100 Commerce Way
Clovis, NM 88101
Phone (575) 762-0360

1511 S Grand Ave
Roswell, NM 88203
Phone (505) 623-3255

Ownership & related parties

All disclosed owners & managing parties 10

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 Director Jul 1, 2017
Margaret Tarango Individual Corporate Director Jul 1, 2017
Isabell Walla Individual Corporate Director Jul 1, 2017
Veronica Apodaca Individual Corporate DirectorBoard Member Jan 1, 2023
Lisa Jaynes Individual Corporate Director Jan 23, 2019
Katherine McClain Individual Corporate Director Jan 26, 2022
Carmen Pacheco-Munoz Individual W-2 Managing EmployeeAd;Ceo May 27, 2026
Desiree Smith Individual Corporate DirectorBoard Member Jan 1, 2025
Veronica Cordova Individual Corporate Director Jul 1, 2017
Warren a Yehl Individual Corporate Director Jan 26, 2022

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1760788137",
    "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": "881300843",
            "telephone_number": "575-356-6695",
            "fax_number": "575-356-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COMMERCE WAY",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014768",
            "telephone_number": "575-769-4410",
            "fax_number": "575-763-9154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CASA DE BUENA SALUD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2018-03-29",
        "status": "A",
        "authorized_official_last_name": "MONTANO",
        "authorized_official_first_name": "SEFERINO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-356-6695"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Casa School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Casa School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clovis, NM

Sources for this page

Verify at the official NPI Registry.