| NPI | 1750846143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA PATRICE BAGSBY Administrator 310-925-8857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2019-02-10 |
| Last Update Date | 2019-09-16 |