Provider Demographics
NPI:1922401421
Name:CASA SAN MIGUEL, LLC
Entity Type:Organization
Organization Name:CASA SAN MIGUEL, LLC
Other - Org Name:CASA LOS PADRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMYATINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-455-9953
Mailing Address - Street 1:908 VIA LOS PADRES
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:908 VIA LOS PADRES
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1326
Practice Address - Country:US
Practice Address - Phone:805-455-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425801721310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility