Provider Demographics
NPI:1841640307
Name:CASA CAPRI
Entity type:Organization
Organization Name:CASA CAPRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-533-4285
Mailing Address - Street 1:4001 WESTERLY PL STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2302
Mailing Address - Country:US
Mailing Address - Phone:877-713-2669
Mailing Address - Fax:877-963-6329
Practice Address - Street 1:671 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2504
Practice Address - Country:US
Practice Address - Phone:877-713-2669
Practice Address - Fax:877-820-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300326CPOtherDHCS