Provider Demographics
NPI:1497815823
Name:LA CASA AZUL DE PAZ
Entity Type:Organization
Organization Name:LA CASA AZUL DE PAZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVARRIA-SOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-339-0767
Mailing Address - Street 1:10614 MAC MORA ROAD
Mailing Address - Street 2:P.O. BOX 80063
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-339-0767
Mailing Address - Fax:
Practice Address - Street 1:10614 MACMORA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4616
Practice Address - Country:US
Practice Address - Phone:512-339-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities