Provider Demographics
NPI:1023458833
Name:CASABLANCA HOMECARE
Entity type:Organization
Organization Name:CASABLANCA HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA LUISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDREAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-357-1417
Mailing Address - Street 1:17216 GOYA STREET
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-357-1417
Mailing Address - Fax:818-366-2234
Practice Address - Street 1:17216 GOYA ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-1206
Practice Address - Country:US
Practice Address - Phone:818-357-1417
Practice Address - Fax:818-366-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608511310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility