Provider Demographics
NPI:1619680386
Name:CASA COMPANION HOMECARE LLC
Entity Type:Organization
Organization Name:CASA COMPANION HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANJUHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-974-7010
Mailing Address - Street 1:37808 W SANTA BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5416
Mailing Address - Country:US
Mailing Address - Phone:502-431-4045
Mailing Address - Fax:
Practice Address - Street 1:37808 W SANTA BARBARA AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5416
Practice Address - Country:US
Practice Address - Phone:502-431-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility