MEDICARE: CASA DOMINICANA, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1699962506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA DOMINICANA, INC

Provider Business Mailing Address
First Line	:	1921 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3121
Country	:	US
Telephone Number	:	267-997-5339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3121
Country	:	US
Telephone Number	:	267-997-5339
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS SANDRA ZORRILLA
Credential	:	MD
Telephone Number	:	267-997-5339

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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