Healthcare Provider Details

I. General information

NPI: 1134593833
Provider Name (Legal Business Name): CASA PACIFICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 LEWIS RD 268
CAMARILLO CA
93012-0234
US

IV. Provider business mailing address

1722 S LEWIS RD NONE
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-445-7800
  • Fax: 805-987-0258
Mailing address:
  • Phone: 805-445-7800
  • Fax: 805-987-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMFC2900
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberMFC29100
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMFC29100
License Number StateCA

VIII. Authorized Official

Name: MRS. HEATHER NONE CAMPBELL
Title or Position: ADMINASTRATION
Credential:
Phone: 805-445-7800