Healthcare Provider Details

I. General information

NPI: 1174230650
Provider Name (Legal Business Name): CASA DE AMPARO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BUENA CREEK RD
SAN MARCOS CA
92069-9679
US

IV. Provider business mailing address

325 BUENA CREEK RD
SAN MARCOS CA
92069-9679
US

V. Phone/Fax

Practice location:
  • Phone: 760-754-5500
  • Fax:
Mailing address:
  • Phone: 760-754-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHEENA BERGERON
Title or Position: CHIEF PROGRAM OFFICER
Credential:
Phone: 760-566-3587