MEDICARE: CASA CAPRI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility
2	324500000X	Substance Abuse Rehabilitation Facility	300326DP	CA

General Provider Information

NPI Number	:	1013426816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA CAPRI

Provider Business Mailing Address
First Line	:	4001 WESTERLY PL STE 110
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	687 GOVERNOR ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2504
Country	:	US
Telephone Number	:	877-713-2669
Fax Number	:

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	IAN ROY
Credential	:
Telephone Number	:	949-335-7598

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	05/20/2020

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