Healthcare Provider Details

I. General information

NPI: 1831430156
Provider Name (Legal Business Name): CASA CENTRAL SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 08/20/2015
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
US

V. Phone/Fax

Practice location:
  • Phone: 773-645-2300
  • Fax: 773-645-2335
Mailing address:
  • Phone: 773-645-2300
  • Fax: 773-862-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number251V00000X
License Number StateIL

VIII. Authorized Official

Name: MRS. ANN RUTH ALVAREZ
Title or Position: PRESIDENT & CEO
Credential:
Phone: 773-645-2300