Provider Demographics
NPI:1407482094
Name:CASA PROVIDER SERVICES, LLC
Entity Type:Organization
Organization Name:CASA PROVIDER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-878-5041
Mailing Address - Street 1:1980 COUNTRY PLACE PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2137
Mailing Address - Country:US
Mailing Address - Phone:832-878-5041
Mailing Address - Fax:713-588-2416
Practice Address - Street 1:1980 COUNTRY PLACE PKWY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2137
Practice Address - Country:US
Practice Address - Phone:832-878-5041
Practice Address - Fax:713-588-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care