Provider Demographics
NPI:1699962506
Name:CASA DOMINICANA, INC
Entity type:Organization
Organization Name:CASA DOMINICANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZORRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-997-5339
Mailing Address - Street 1:1921 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-3121
Mailing Address - Country:US
Mailing Address - Phone:267-997-5339
Mailing Address - Fax:
Practice Address - Street 1:1921 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3121
Practice Address - Country:US
Practice Address - Phone:267-997-5339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health