Basic Information
| Provider Information | |||||||||
| NPI: | 1033292925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASA COLINA CENTERS FOR REHABILITATION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917696001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095967733 | ||||||||
| FaxNumber: | 9095939417 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E BONITA AVENUE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095967733 | ||||||||
| FaxNumber: | 9095937541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOVERSO | ||||||||
| AuthorizedOfficialFirstName: | FELICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 9095967733 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320700000X | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities |
No ID Information.