Provider Demographics
NPI:1629255393
Name:CASA AZUL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CASA AZUL ENTERPRISES, INC.
Other - Org Name:MISSION WELLNESS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:AVENDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-526-0070
Mailing Address - Street 1:685 E COCHRAN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1925
Mailing Address - Country:US
Mailing Address - Phone:805-526-0070
Mailing Address - Fax:805-526-0077
Practice Address - Street 1:685 E COCHRAN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1925
Practice Address - Country:US
Practice Address - Phone:805-526-0070
Practice Address - Fax:805-526-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health