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General NPI Number Information
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NPI Number | 1497992895
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Entity Type | Organization
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Legal Business Name | CASA GRANDE SR. CARE HOME
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 347 E WALNUT AVE
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City | VISALIA
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State | CA
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Zip | 93277-5458
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Country | US
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Telephone | 559-733-0233
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Fax | 559-733-7503
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Provider Business Mailing Address
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Address Line | 347 E WALNUT AVE
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City | VISALIA
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State | CA
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Zip | 93277-5458
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Country | US
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Telephone | 559-733-0233
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Fax | 559-733-7503
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Authorized Official
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Title or Position | JR. ADMINISTRATOR
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Name | MRS. LISAMARIE SILVEIRA REIMER
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Credential |
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Telephone | 559-733-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 540404321
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 540405657
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License Number State | CA
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