1922276062 NPI number — CASA DE LAS AMIGAS

Table of content: (NPI 1922276062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922276062 NPI number — CASA DE LAS AMIGAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASA DE LAS AMIGAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CASA TREATMENT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922276062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 N EL MOLINO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-792-2770
Provider Business Mailing Address Fax Number:
626-792-5826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 N EL MOLINO AVE
Provider Second Line Business Practice Location Address:
173 NORTH OAK KNOLL AVE
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91101-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-792-2770
Provider Business Practice Location Address Fax Number:
626-792-5826
Provider Enumeration Date:
02/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODEMICH
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
NOEL
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
626-792-2770

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  190012CN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)