Provider Demographics
NPI:1891301552
Name:CASABLANCA CARE CENTER, LLC
Entity Type:Organization
Organization Name:CASABLANCA CARE CENTER, LLC
Other - Org Name:CASABLANCA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-599-9911
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-599-9911
Mailing Address - Fax:417-777-3024
Practice Address - Street 1:524 S. ALBANY AVENUE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-777-8040
Practice Address - Fax:417-777-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health