Provider Demographics
NPI:1093257545
Name:CASA EDITHAFOUNDATION INC.
Entity Type:Organization
Organization Name:CASA EDITHAFOUNDATION INC.
Other - Org Name:AVALYN'S GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANZADO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:626-374-7294
Mailing Address - Street 1:1756 N HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1429
Mailing Address - Country:US
Mailing Address - Phone:626-794-3916
Mailing Address - Fax:626-696-3929
Practice Address - Street 1:1756 N HILL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1429
Practice Address - Country:US
Practice Address - Phone:626-794-3916
Practice Address - Fax:626-696-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191222785320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities