Basic Information
| Provider Information | |||||||||
| NPI: | 1497939847 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASA DE VIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 MILL ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753291070 | ||||||||
| FaxNumber: | 7753299703 | ||||||||
| Practice Location | |||||||||
| Address1: | 1290 MILL ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753291070 | ||||||||
| FaxNumber: | 7753299703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2007 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | LUEVANO | ||||||||
| AuthorizedOfficialFirstName: | VALERIE | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEUCTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7753293211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.