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General NPI Number Information
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NPI Number | 1841354354
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Entity Type | Organization
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Legal Business Name | CASA PACIFICA
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 23442 EL TORO RD
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City | LAKE FOREST
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State | CA
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Zip | 92630-6979
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Country | US
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Telephone | 949-472-4700
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Fax | 949-855-0428
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Provider Business Mailing Address
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Address Line | 23442 EL TORO RD
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City | LAKE FOREST
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State | CA
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Zip | 92630-6979
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Country | US
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Telephone | 949-472-4700
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Fax | 949-855-0428
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Authorized Official
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Title or Position | OWNER/CEO
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Name | CHERYL ROSKAMP
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Credential |
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Telephone | 949-489-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 300606831
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 060000246
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License Number State | CA
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