Provider Demographics
NPI:1154413854
Name:CASA PACIFICA CENTERS FOR CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:CASA PACIFICA CENTERS FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-366-4343
Mailing Address - Street 1:1722 S LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8520
Mailing Address - Country:US
Mailing Address - Phone:805-445-7800
Mailing Address - Fax:805-987-7237
Practice Address - Street 1:1744 SOUTH LEWIS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-445-7800
Practice Address - Fax:805-987-7237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA PACIFICA CENTERS FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322D00000X
CA050000417261QH0100X
CA1566-00-02322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050000417OtherDEPT. PUBLIC HEALTH LICENSE
CACMM70656FOtherMEDI-CAL LEGACY NUMBER
CA00275OtherDMH LEGAL ENTITY NUMBER