Provider Demographics
NPI:1326339441
Name:CASA JUANA MARIA
Entity Type:Organization
Organization Name:CASA JUANA MARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:TORBIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECH
Authorized Official - Phone:503-341-9807
Mailing Address - Street 1:617 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1664
Mailing Address - Country:US
Mailing Address - Phone:805-963-5021
Mailing Address - Fax:
Practice Address - Street 1:617 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1664
Practice Address - Country:US
Practice Address - Phone:805-963-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness