Provider Demographics
NPI:1154447761
Name:CASA PACIFICA CENTERS FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:CASA PACIFICA CENTERS FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:805-366-4343
Mailing Address - Street 1:1722 S. LEWIS ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8520
Mailing Address - Country:US
Mailing Address - Phone:805-366-4040
Mailing Address - Fax:805-987-7237
Practice Address - Street 1:751 E. DAILY DRIVE
Practice Address - Street 2:SUITE 320
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0772
Practice Address - Country:US
Practice Address - Phone:805-366-4040
Practice Address - Fax:805-987-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70656FMedicaid
CA00275OtherDMH LEGAL ENTITY NUMBER