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Organization
TYLYCE FARMS
Active
Organization
TYLYCE FARMS
Active
Parent organization
MAGENTA SKY PR
Other names
MAGENTA HAZE PR
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAGENTA SKY PR
Authorized official
CHARDE PETRUS DSD (DIRECTOR)
(661) 797-4018
Entity
Organization
Contact information
Practice address
1937 E 111TH ST, LOS ANGELES, CA 90059-2001
(661) 797-4018
Mailing address
3231 KEY LARGO DR APT 202, LAS VEGAS, NV 89120-5304
(925) 332-8810
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
167G00000X
Licensed Psychiatric Technician
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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