Healthcare Provider Details

I. General information

NPI: 1477981447
Provider Name (Legal Business Name): CASA RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31877 DEL OBISPO ST STE 104
SAN JUAN CAPISTRANO CA
92675-3209
US

IV. Provider business mailing address

PO BOX 7658
CAPISTRANO BEACH CA
92624-7658
US

V. Phone/Fax

Practice location:
  • Phone: 888-928-2272
  • Fax: 949-284-0574
Mailing address:
  • Phone: 888-928-2272
  • Fax: 949-284-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300268AP
License Number StateCA

VIII. Authorized Official

Name: DEBRA KRISHNA JESSICK
Title or Position: EXECUTIVE DIRECTOR
Credential: CATC
Phone: 949-289-2752