Organization
THE OLIVE LEAF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY PHILIP FRIEDMAN M.A. (ADMINISTRATOR)
(818) 231-4283
Entity
Organization
Contact information
Practice address
19133 INGOMAR ST, RESEDA, CA 91335-1720
(818) 360-3317
(818) 357-2437
Mailing address
19133 INGOMAR ST, RESEDA, CA 91335-1720
(818) 360-3317
(818) 357-2437
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
960001402
CA
Other
Enumeration date
09/21/2006
Last updated
01/19/2024
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