Provider Demographics
NPI:1245788728
Name:CASA COLINA LLC
Entity Type:Organization
Organization Name:CASA COLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMISSIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-995-9566
Mailing Address - Street 1:1041 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-8304
Mailing Address - Country:US
Mailing Address - Phone:972-449-2000
Mailing Address - Fax:972-449-2100
Practice Address - Street 1:1041 RUTHERFORD ROAD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-8304
Practice Address - Country:US
Practice Address - Phone:972-449-2000
Practice Address - Fax:972-449-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility