Organization
SOLTA DEVELOPMENT LLC
Active
Other names
Long Beach Residential
Organization subpart
No
Provider details
NPI number
Authorized official
TEODULO BONZON (ADMINISTRATOR)
(818) 846-4469
Entity
Organization
Contact information
Practice address
4201 E 10TH ST, LONG BEACH, CA 90804-5508
(818) 846-4469
Mailing address
3013 ANNITA DR, GLENDALE, CA 91206-1302
(818) 846-4469
(818) 457-5577
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/03/2020
Last updated
01/03/2020
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