MEDICARE: CASA RECOVERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		CA

General Provider Information

NPI Number	:	1245664127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA RECOVERY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 7658
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-7658
Country	:	US
Telephone Number	:	888-928-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	31877 DEL OBISPO ST
Second Line	:	SUITE 104
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3233
Country	:	US
Telephone Number	:	888-928-2272
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DEBRA KRISHNA JESSICK
Credential	:
Telephone Number	:	949-289-2752

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	11/20/2018

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