Healthcare Provider Details

I. General information

NPI: 1942577481
Provider Name (Legal Business Name): CASA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 PIER AVE STE B143
HERMOSA BEACH CA
90254-3960
US

IV. Provider business mailing address

703 PIER AVE STE B143
HERMOSA BEACH CA
90254-3960
US

V. Phone/Fax

Practice location:
  • Phone: 323-634-1940
  • Fax: 323-634-1943
Mailing address:
  • Phone: 323-634-1940
  • Fax: 323-634-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL SOLORZANO
Title or Position: SOLE MEMBER
Credential:
Phone: 323-634-1940