Provider Demographics
NPI:1710308531
Name:CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE
Entity Type:Organization
Organization Name:CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE
Other - Org Name:CASA ELANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-479-0720
Mailing Address - Street 1:1905 N. COLLEGE STREET, SUITE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706
Mailing Address - Country:US
Mailing Address - Phone:714-479-0120
Mailing Address - Fax:714-479-0153
Practice Address - Street 1:832 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5201
Practice Address - Country:US
Practice Address - Phone:714-772-5580
Practice Address - Fax:714-772-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300010BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300010BNOtherDEPARTMENT OF ALCOHOL AND DRUG PROGRAMS