Organization
GRACEFUL SENESCENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON SELICO (PRESIDENT)
(323) 293-7072
Entity
Organization
Contact information
Practice address
120 W EL SEGUNDO BLVD, LOS ANGELES, CA 90061-1628
(310) 538-5808
(310) 538-5406
Mailing address
120 W EL SEGUNDO BLVD, LOS ANGELES, CA 90061-1628
(310) 538-5808
(310) 538-5406
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
060000630
CA
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060000630
—
CA
05
—
ADU70181G
—
CA
Enumeration date
08/31/2006
Last updated
05/03/2023
Update your record
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