Basic Information
| Provider Information | |||||||||
| NPI: | 1154447761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASA PACIFICA CENTERS FOR CHILDREN AND FAMILIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1722 S. LEWIS ROAD | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930128520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053664040 | ||||||||
| FaxNumber: | 8059877237 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 E. DAILY DRIVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930100772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053664040 | ||||||||
| FaxNumber: | 8059877237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | SHAWNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8053664343 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | CMM70656F | 05 | CA | MEDICAID | 00275 | 01 | CA | DMH LEGAL ENTITY NUMBER | OTHER |