Healthcare Provider Details

I. General information

NPI: 1861312100
Provider Name (Legal Business Name): CASA SRF OPCO III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750B S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

PO BOX 12125
PORTLAND OR
97212-0125
US

V. Phone/Fax

Practice location:
  • Phone: 805-850-8436
  • Fax:
Mailing address:
  • Phone: 858-254-2510
  • Fax: 858-254-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAD ENGBRECHT
Title or Position: GENERAL COUNSEL
Credential: ENGBRECHT
Phone: 858-254-2510