MEDICARE: CASA AZUL ENTERPRISES, INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629255393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA AZUL ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	685 E COCHRAN ST
Second Line	:	SUITE 210
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1925
Country	:	US
Telephone Number	:	805-526-0070
Fax Number	:	805-526-0077

Provider Business Practice Location Address
First Line	:	685 E COCHRAN ST
Second Line	:	SUITE 210
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1925
Country	:	US
Telephone Number	:	805-526-0070
Fax Number	:	805-526-0077

Authorized Official
Title or Position	:	CEO/CFO
Name	:	MR. EUGENE RAMON AVENDANO
Credential	:
Telephone Number	:	805-526-0070

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	02/29/2008

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