Provider Demographics
NPI:1245615418
Name:MI CASA ES SU CASA INC
Entity Type:Organization
Organization Name:MI CASA ES SU CASA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPAT
Authorized Official - Phone:443-559-0405
Mailing Address - Street 1:3921 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1910
Mailing Address - Country:US
Mailing Address - Phone:443-219-7855
Mailing Address - Fax:
Practice Address - Street 1:3921 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1910
Practice Address - Country:US
Practice Address - Phone:443-219-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility