Provider Demographics
NPI:1780015875
Name:CASA BELLA RECOVERY CENTER, LLP
Entity Type:Organization
Organization Name:CASA BELLA RECOVERY CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAN JUANA
Authorized Official - Middle Name:VIVIANA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCDC, QMHP
Authorized Official - Phone:956-774-7900
Mailing Address - Street 1:5601 PADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PADRE ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78597-7450
Mailing Address - Country:US
Mailing Address - Phone:956-774-7900
Mailing Address - Fax:
Practice Address - Street 1:5601 PADRE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597-7450
Practice Address - Country:US
Practice Address - Phone:956-774-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility