Provider Demographics
NPI:1568840379
Name:CASA MARINA AT NORTHRIDGE, INC.
Entity Type:Organization
Organization Name:CASA MARINA AT NORTHRIDGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:MARINA
Authorized Official - Last Name:ALONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-554-3202
Mailing Address - Street 1:17029 ROMAR ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1640
Mailing Address - Country:US
Mailing Address - Phone:818-349-3011
Mailing Address - Fax:818-772-4240
Practice Address - Street 1:17029 ROMAR ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1640
Practice Address - Country:US
Practice Address - Phone:818-349-3011
Practice Address - Fax:818-772-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197605786311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home