Provider Demographics
NPI:1497992895
Name:CASA GRANDE SR. CARE HOME
Entity Type:Organization
Organization Name:CASA GRANDE SR. CARE HOME
Other - Org Name:CASA GRANDE SR. CARE HOME & ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:JR. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISAMARIE
Authorized Official - Middle Name:SILVEIRA
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-733-0233
Mailing Address - Street 1:347 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5458
Mailing Address - Country:US
Mailing Address - Phone:559-733-0233
Mailing Address - Fax:559-733-7503
Practice Address - Street 1:347 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5458
Practice Address - Country:US
Practice Address - Phone:559-733-0233
Practice Address - Fax:559-733-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540404321320800000X
CA540405657320800000X
323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility