MEDICARE: CASA DE ALAS RESIDENTIAL

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		TX

General Provider Information

NPI Number	:	1033310073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA DE ALAS RESIDENTIAL

Provider Business Mailing Address
First Line	:	2603 CAMPDEN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4840
Country	:	US
Telephone Number	:	512-699-4353
Fax Number	:	512-462-9528

Provider Business Practice Location Address
First Line	:	2603 CAMPDEN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4840
Country	:	US
Telephone Number	:	512-699-4353
Fax Number	:	512-462-9528

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER ALAS
Credential	:
Telephone Number	:	512-699-4353

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/22/2020

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