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NPI Code Detail

MEDICARE: CASA DE LAGO

MEDICARE: CASA DE LAGO
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
1283Q00000XPsychiatric HospitalCA

General Provider Information

NPI Number : 1255357760
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASA DE LAGO
Provider Business Mailing Address
First Line : 23700 CAMINO DEL SOL
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5017
Country : US
Telephone Number : 310-530-1151
Fax Number :
Provider Business Practice Location Address
First Line : 22590 CANYON LAKE DR S
Second Line :
City : CANYON LAKE
State : CA
Zip : 92587-7560
Country : US
Telephone Number : 310-530-1151
Fax Number :
Authorized Official
Title or Position : CFO/ SR VP
Name : STEVE FILTON
Credential :
Telephone Number : 610-768-3300
Provider Enumeration Date : 07/15/2006
Last Update Date : 06/09/2009

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Directions to “CASA DE LAGO ” Practice Location

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