Provider Demographics
NPI:1780214254
Name:MI CASA TRANSITIONAL SERVICES INC
Entity Type:Organization
Organization Name:MI CASA TRANSITIONAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-214-4755
Mailing Address - Street 1:1611 CRESTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2727
Mailing Address - Country:US
Mailing Address - Phone:719-214-4755
Mailing Address - Fax:
Practice Address - Street 1:1611 CRESTMOOR DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2727
Practice Address - Country:US
Practice Address - Phone:719-214-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management