Provider Demographics
NPI:1134593833
Name:CASA PACIFICA
Entity type:Organization
Organization Name:CASA PACIFICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINASTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-445-7800
Mailing Address - Street 1:1722 S LEWIS RD
Mailing Address - Street 2:NONE
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8520
Mailing Address - Country:US
Mailing Address - Phone:805-445-7800
Mailing Address - Fax:805-987-0258
Practice Address - Street 1:1722 LEWIS RD
Practice Address - Street 2:268
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-0234
Practice Address - Country:US
Practice Address - Phone:805-445-7800
Practice Address - Fax:805-987-0258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC2900320800000X
CAMFC291003245S0500X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children