Provider Demographics
NPI:1700239118
Name:CASA DE BELLAMIE, LLC
Entity Type:Organization
Organization Name:CASA DE BELLAMIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:JACQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-775-1965
Mailing Address - Street 1:7235 N. LOOP DR.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915
Mailing Address - Country:US
Mailing Address - Phone:915-775-1965
Mailing Address - Fax:915-775-1965
Practice Address - Street 1:7235 N LOOP DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-2412
Practice Address - Country:US
Practice Address - Phone:915-775-1965
Practice Address - Fax:915-775-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143878320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities