Provider Demographics
NPI:1679919617
Name:MEXICAN AMERICAN ADDICTION PROGRAM
Entity Type:Organization
Organization Name:MEXICAN AMERICAN ADDICTION PROGRAM
Other - Org Name:MI CASA RECOVERY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-394-2323
Mailing Address - Street 1:4241 FLORIN RD STE 65
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2535
Mailing Address - Country:US
Mailing Address - Phone:916-394-2323
Mailing Address - Fax:916-394-2480
Practice Address - Street 1:2515 48TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3810
Practice Address - Country:US
Practice Address - Phone:916-394-2328
Practice Address - Fax:916-339-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340004BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility