Provider Demographics
NPI:1255357760
Name:CASA DE LAGO
Entity type:Organization
Organization Name:CASA DE LAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/ SR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:23700 CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5017
Mailing Address - Country:US
Mailing Address - Phone:310-530-1151
Mailing Address - Fax:
Practice Address - Street 1:22590 CANYON LAKE DR S
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7560
Practice Address - Country:US
Practice Address - Phone:310-530-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital