Provider Demographics
NPI:1023141231
Name:CASA DE AMPARO
Entity type:Organization
Organization Name:CASA DE AMPARO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:SUTYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:760-566-3578
Mailing Address - Street 1:325 BUENA CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069
Mailing Address - Country:US
Mailing Address - Phone:760-754-5500
Mailing Address - Fax:760-757-0792
Practice Address - Street 1:325 BUENA CREEK ROAD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069
Practice Address - Country:US
Practice Address - Phone:760-754-5510
Practice Address - Fax:750-754-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children