Provider Demographics
NPI:1851917033
Name:CASA DE LAS AMIGAS
Entity Type:Organization
Organization Name:CASA DE LAS AMIGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEMICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:626-792-2770
Mailing Address - Street 1:160 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1805
Mailing Address - Country:US
Mailing Address - Phone:626-792-2770
Mailing Address - Fax:
Practice Address - Street 1:173 N OAK KNOLL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-792-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No177F00000XOther Service ProvidersLodging