Organization
EMQ HOLLYGROVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERIC MARTEZ HORTON BA MHRS (DAY REHABILITATION SPECIALIST)
(323) 463-2119
Entity
Organization
Contact information
Practice address
815 N EL CENTRO AVE, LOS ANGELES, CA 90038-3805
(323) 463-2119
Mailing address
950 S WESTMORELAND AVE, APT. 202, LOS ANGELES, CA 90006-5669
(213) 252-8577
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
322D00000X
CA
Other
Enumeration date
06/25/2007
Last updated
08/22/2020
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