Healthcare Provider Details

I. General information

NPI: 1689749046
Provider Name (Legal Business Name): LA CASA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 BACKWATER TERRACE
N. CHESTERFIELD VA
23234
US

IV. Provider business mailing address

P.O. BOX 72922
N. CHESTERFIELD VA
23235-2922
US

V. Phone/Fax

Practice location:
  • Phone: 804-353-0461
  • Fax: 804-497-7401
Mailing address:
  • Phone: 804-353-0461
  • Fax: 804-497-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TIA LASHE' HICKSON
Title or Position: VP/COO
Credential:
Phone: 804-353-0461