Provider Demographics
NPI:1447769443
Name:CASA ESPERANZA, INC.
Entity Type:Organization
Organization Name:CASA ESPERANZA, INC.
Other - Org Name:CASA ESPERANZA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-445-1123
Mailing Address - Street 1:302 EUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3800
Mailing Address - Country:US
Mailing Address - Phone:617-445-1123
Mailing Address - Fax:
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:617-445-1123
Practice Address - Fax:617-445-1123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA ESPERANZA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0820261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health