Provider Demographics
NPI:1922276062
Name:CASA DE LAS AMIGAS
Entity Type:Organization
Organization Name:CASA DE LAS AMIGAS
Other - Org Name:CASA TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:RODEMICH
Authorized Official - Suffix:
Authorized Official - Credentials:
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
Mailing Address - Country:US
Mailing Address - Phone:626-792-2770
Mailing Address - Fax:626-792-5826
Practice Address - Street 1:160 N EL MOLINO AVE
Practice Address - Street 2:173 NORTH OAK KNOLL AVE
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1805
Practice Address - Country:US
Practice Address - Phone:626-792-2770
Practice Address - Fax:626-792-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190012CN101YA0400X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty