Provider Demographics
NPI:1902319445
Name:THE CONSTELLATION
Entity Type:Organization
Organization Name:THE CONSTELLATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:MARCELL
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:CAADE, CSC
Authorized Official - Phone:619-847-5174
Mailing Address - Street 1:1101 ALTURAS RD APT 1E
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3127
Mailing Address - Country:US
Mailing Address - Phone:619-847-5174
Mailing Address - Fax:
Practice Address - Street 1:11201 CONSTELLATION DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-8200
Practice Address - Country:US
Practice Address - Phone:619-847-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility