Healthcare Provider Details

I. General information

NPI: 1053742445
Provider Name (Legal Business Name): CASA CENTRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 N CALIFORNIA AVE
CHICAGO IL
60622-2803
US

IV. Provider business mailing address

1343 N CALIFORNIA AVE
CHICAGO IL
60622-2803
US

V. Phone/Fax

Practice location:
  • Phone: 773-645-2300
  • Fax: 773-645-2475
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: MRS. ANN R ALVAREZ
Title or Position: PRESIDENT & CEO
Credential:
Phone: 773-645-2324