Provider Demographics
NPI:1730457284
Name:CASA FAMILY SYSTEMS
Entity Type:Organization
Organization Name:CASA FAMILY SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LABRENA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:AIKEN-FURTICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:803-534-2448
Mailing Address - Street 1:658 JOHN C. CALHOUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115
Mailing Address - Country:US
Mailing Address - Phone:803-534-2448
Mailing Address - Fax:803-534-2594
Practice Address - Street 1:658 JOHN C. CALHOUN DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115
Practice Address - Country:US
Practice Address - Phone:803-534-2448
Practice Address - Fax:803-534-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNON APPLICABLE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty