Healthcare Provider Details

I. General information

NPI: 1952633240
Provider Name (Legal Business Name): CASA DE LAS AMIGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N OAK KNOLL AVENUE
PASADENA CA
91101
US

IV. Provider business mailing address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-2770
  • Fax:
Mailing address:
  • Phone: 626-792-2770
  • Fax: 626-792-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number190012BN
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190012BN
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190012BN
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: NELY E MEZA
Title or Position: CEO
Credential:
Phone: 323-854-2160