MEDICARE: CASA PALMERA CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	323P00000X	Psychiatric Residential Treatment Facility
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1669468286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA PALMERA CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	18401 VON KARMAN AVE STE 500
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-8531
Country	:	US
Telephone Number	:	714-828-1800
Fax Number	:	714-882-1186

Provider Business Practice Location Address
First Line	:	14750 EL CAMINO REAL
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-4204
Country	:	US
Telephone Number	:	714-828-1800
Fax Number	:	714-882-1186

Authorized Official
Title or Position	:	DIRECTOR OF PAYER RELATIONS
Name	:	MAGDALEN GUSTILO
Credential	:
Telephone Number	:	714-568-7667

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/23/2024

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