Provider Demographics
NPI:1669362372
Name:CASITA DE IXCHELL LLC
Entity type:Organization
Organization Name:CASITA DE IXCHELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCAMILLA DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-246-6652
Mailing Address - Street 1:1204 JUNCTION ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2461
Mailing Address - Country:US
Mailing Address - Phone:323-225-8685
Mailing Address - Fax:
Practice Address - Street 1:1204 JUNCTION ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2461
Practice Address - Country:US
Practice Address - Phone:323-225-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health