# CASA PACIFICA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 5450
- **Other names:** none
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1295109817
- **Legal business name:** 5450
- **Authorized official:** MRS. MIZELLA NONE HAYWOOD ADMINSTRATION (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (805) 445-7800

## Contact information

- **Practice address:** 1021 SCANDIA AVE, 49, VENTURA, CA 93004-2473
- **Practice address phone:** (805) 248-1705
- **Practice address fax:** (805) 987-0258
- **Mailing address:** 1722 LEWIS ROAD, 49, CAMIRRILO, CA 93004-2610
- **Mailing address phone:** (805) 445-7800
- **Mailing address fax:** (805) 987-0258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MFC29100 | CA | Yes |

## Other

- **Enumeration date:** 11/19/2015
- **Last updated:** 11/19/2015