Healthcare Provider Details

I. General information

NPI: 1902090285
Provider Name (Legal Business Name): CASA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 WARREN AVE
PORTLAND ME
04103-1007
US

IV. Provider business mailing address

PO BOX 150
WESTBROOK ME
04098-0150
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-6165
  • Fax: 207-879-7466
Mailing address:
  • Phone: 207-879-6165
  • Fax: 207-879-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number36670
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateME

VIII. Authorized Official

Name: MS. ANNE D WALP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-879-6165