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NPI Code Detail

MEDICARE: CASA SOLUNA LLC

MEDICARE: CASA SOLUNA LLC
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
1251S00000XCommunity/Behavioral Health Agency
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3251B00000XCase Management Agency
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1801676093
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASA SOLUNA LLC
Provider Business Mailing Address
First Line : 1653 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1309
Country : US
Telephone Number : 708-613-7862
Fax Number :
Provider Business Practice Location Address
First Line : 1653 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1309
Country : US
Telephone Number : 708-613-7862
Fax Number :
Authorized Official
Title or Position : FOUNDER/EXECUTIVE DIRECTOR
Name : JESSICA CARRILLO-GUERRERO
Credential : LCPC
Telephone Number : 773-615-5415
Provider Enumeration Date : 10/04/2023
Last Update Date : 12/13/2023

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