Healthcare Provider Details

I. General information

NPI: 1023430543
Provider Name (Legal Business Name): CASA CENTRAL SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 NORTH CALIFORNIA AVENUE
CHICAGO IL
60622
US

IV. Provider business mailing address

1343 N CALIFORNIA AVE
CHICAGO IL
60622-2803
US

V. Phone/Fax

Practice location:
  • Phone: 773-645-2376
  • Fax: 773-276-2269
Mailing address:
  • Phone: 773-645-2300
  • Fax: 773-645-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN R. CASTRO
Title or Position: INTERIM PRESIDENT & CEO
Credential:
Phone: 773-645-2300