Provider Demographics
NPI:1013105311
Name:LACASA PERSONAL CARE
Entity Type:Organization
Organization Name:LACASA PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:SPOKLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-765-1669
Mailing Address - Street 1:408 LASATER AVE
Mailing Address - Street 2:
Mailing Address - City:PLENTYWOOD
Mailing Address - State:MT
Mailing Address - Zip Code:59254-2070
Mailing Address - Country:US
Mailing Address - Phone:406-765-1669
Mailing Address - Fax:406-765-2886
Practice Address - Street 1:408 LASATER AVE
Practice Address - Street 2:
Practice Address - City:PLENTYWOOD
Practice Address - State:MT
Practice Address - Zip Code:59254-2070
Practice Address - Country:US
Practice Address - Phone:406-765-1669
Practice Address - Fax:406-765-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11247310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7752102Medicaid