Provider Demographics
NPI:1053883066
Name:MI CASA ES SU CASA INC
Entity type:Organization
Organization Name:MI CASA ES SU CASA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-708-8381
Mailing Address - Street 1:3921 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1910
Mailing Address - Country:US
Mailing Address - Phone:443-563-6280
Mailing Address - Fax:
Practice Address - Street 1:3921 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1910
Practice Address - Country:US
Practice Address - Phone:443-563-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MI CASA ES SU CASA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH001393OtherBEHAV HLTH ADMIN