Provider Demographics
NPI:1730681685
Name:CASA DE LOS NINOS, INC.
Entity type:Organization
Organization Name:CASA DE LOS NINOS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-471-2206
Mailing Address - Street 1:1120 N 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705
Mailing Address - Country:US
Mailing Address - Phone:520-624-5600
Mailing Address - Fax:520-881-1648
Practice Address - Street 1:1120 N 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-624-5600
Practice Address - Fax:520-623-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING251S00000X
AZOTC-8835251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ502818Medicaid