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General NPI Number Information
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NPI Number | 1245788728
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Entity Type | Organization
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Legal Business Name | CASA COLINA LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 1041 RUTHERFORD ROAD
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City | WAXAHACHIE
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State | TX
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Zip | 75165-8304
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Country | US
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Telephone | 972-449-2000
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Fax | 972-449-2100
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Provider Business Mailing Address
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Address Line | 1041 RUTHERFORD RD
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City | WAXAHACHIE
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State | TX
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Zip | 75165-8304
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Country | US
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Telephone | 972-449-2000
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Fax | 972-449-2100
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Authorized Official
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Title or Position | DIRECTOR OF ADMISSIONS
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Name | KAY FONTENOT
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Credential | LCSW
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Telephone | 214-995-9566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | TX
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