Provider Demographics
NPI:1043671886
Name:CASA HEALTHCARE LLC
Entity Type:Organization
Organization Name:CASA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:908-255-3076
Mailing Address - Street 1:1345 ENCINITAS BLVD STE 444
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1345 ENCINITAS BLVD STE 444
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2845
Practice Address - Country:US
Practice Address - Phone:908-255-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty