Provider Demographics
NPI:1770912933
Name:CASA BELLA RECOVERY
Entity type:Organization
Organization Name:CASA BELLA RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMONACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-275-7581
Mailing Address - Street 1:31365 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6946
Mailing Address - Country:US
Mailing Address - Phone:949-715-0467
Mailing Address - Fax:866-703-9903
Practice Address - Street 1:31365 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6946
Practice Address - Country:US
Practice Address - Phone:949-715-0467
Practice Address - Fax:866-703-9903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA BELLA RECOVERY INTERNATIONAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-07
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300222AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility