Healthcare Provider Details

I. General information

NPI: 1023054376
Provider Name (Legal Business Name): CASA-TRINITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 MILLENNIUM DRIVE
GENESEO NY
14454-1418
US

IV. Provider business mailing address

4612 MILLENNIUM DR
GENESEO NY
14454-1197
US

V. Phone/Fax

Practice location:
  • Phone: 585-443-2018
  • Fax: 585-991-5013
Mailing address:
  • Phone: 585-443-2018
  • Fax: 585-991-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: REBECCA O
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 607-302-0442