Organization
EXCELLENCE COMMUNITY REHABILITATION PROGRAM LLC
Active
Other names
Excellence Community Residential Properties, ECRP
Organization subpart
No
Provider details
NPI number
Authorized official
MISS OCTAVIA ASKEW PH.D (PROGRAM DIRECTOR/ADMINISTRATOR)
(424) 789-0439
Entity
Organization
Contact information
Practice address
37025 LA CONTEMPO AVE, PALMDALE, CA 93550-7351
(424) 789-0439
Mailing address
1607 E PALMDALE BLVD STE G, PALMDALE, CA 93550-7801
(424) 789-0439
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197610283
ADULT RESIDENTIAL FACILITY LICENSE
CA
Enumeration date
08/16/2022
Last updated
02/22/2023
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