Healthcare Provider Details

I. General information

NPI: 1902893266
Provider Name (Legal Business Name): CASITAS OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10626 BALBOA BLVD
GRANADA HILLS CA
91344-6329
US

IV. Provider business mailing address

10626 BALBOA BLVD ACCOUNTING OFFICE
GRANADA HILLS CA
91344-6329
US

V. Phone/Fax

Practice location:
  • Phone: 818-368-2802
  • Fax: 818-368-0525
Mailing address:
  • Phone: 818-368-2802
  • Fax: 818-368-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT REISS
Title or Position: MANAGER
Credential:
Phone: 818-368-5200