# EMQ HOLLYGROVE

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

## Provider details

- **NPI number:** 1275739401
- **Authorized official:** MR. DERIC MARTEZ HORTON BA MHRS (DAY REHABILITATION SPECIALIST)
- **Authorized official phone:** (323) 463-2119

## Contact information

- **Practice address:** 815 N EL CENTRO AVE, LOS ANGELES, CA 90038-3805
- **Practice address phone:** (323) 463-2119
- **Mailing address:** 950 S WESTMORELAND AVE, APT. 202, LOS ANGELES, CA 90006-5669
- **Mailing address phone:** (213) 252-8577

## Taxonomy

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

## Other

- **Enumeration date:** 06/25/2007
- **Last updated:** 08/22/2020