# COMMUNITY RESIDENTIAL CARE PROGRAM

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

## Provider details

- **NPI number:** 1871691352
- **Authorized official:** MS. DENISE MARIE POLK (REGISTERED NURSE)
- **Authorized official phone:** (310) 478-3711

## Contact information

- **Practice address:** 1416 W 103RD ST, LOS ANGELES, CA 90047-4510
- **Practice address phone:** (323) 777-0269
- **Mailing address:** 1416 W 103RD ST, LOS ANGELES, CA 90047-4510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 483652 | CA | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/22/2020