Provider Demographics
NPI:1902893266
Name:CASITAS OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:CASITAS OPERATING COMPANY LLC
Other - Org Name:CASITAS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-368-5200
Mailing Address - Street 1:10626 BALBOA BLVD
Mailing Address - Street 2:ACCOUNTING OFFICE
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6329
Mailing Address - Country:US
Mailing Address - Phone:818-368-2802
Mailing Address - Fax:818-368-0825
Practice Address - Street 1:10626 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6329
Practice Address - Country:US
Practice Address - Phone:818-368-2802
Practice Address - Fax:818-368-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06148JMedicaid
CAZZT06148JMedicaid
056148Medicare ID - Type Unspecified