# KOLES PLACE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063893006
- **Authorized official:** NEEKOLE GLASPIE (ADMINISTRATOR)
- **Authorized official phone:** (310) 462-2730

## Contact information

- **Practice address:** 8630 RAYFORD DR, LOS ANGELES, CA 90045-3512
- **Practice address phone:** (310) 670-6965
- **Practice address fax:** (424) 227-6024
- **Mailing address:** 8630 RAYFORD DR, LOS ANGELES, CA 90045-3512
- **Mailing address phone:** (310) 670-6965
- **Mailing address fax:** (424) 227-6024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/16/2015
- **Last updated:** 06/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC 60731F | — | CA |