Provider Demographics
NPI:1477981447
Name:CASA RECOVERY, INC.
Entity Type:Organization
Organization Name:CASA RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:JESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:CATC
Authorized Official - Phone:949-289-2752
Mailing Address - Street 1:PO BOX 7658
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-7658
Mailing Address - Country:US
Mailing Address - Phone:888-928-2272
Mailing Address - Fax:949-284-0574
Practice Address - Street 1:31877 DEL OBISPO ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3209
Practice Address - Country:US
Practice Address - Phone:888-928-2272
Practice Address - Fax:949-284-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QR0405X
CA300268AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility