Provider Demographics
NPI:1790299725
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:OFFICIAL AGENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
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:2017-11-29
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000444175T00000X
251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty