Provider Demographics
NPI:1689749046
Name:LA CASA, INC.
Entity Type:Organization
Organization Name:LA CASA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:LASHE'
Authorized Official - Last Name:HICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-353-0461
Mailing Address - Street 1:P.O. BOX 72922
Mailing Address - Street 2:
Mailing Address - City:N. CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2922
Mailing Address - Country:US
Mailing Address - Phone:804-353-0461
Mailing Address - Fax:804-497-7401
Practice Address - Street 1:5621 BACKWATER TERRACE
Practice Address - Street 2:
Practice Address - City:N. CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234
Practice Address - Country:US
Practice Address - Phone:804-353-0461
Practice Address - Fax:804-497-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management