Organization
MARIE'S PRIVATE QUARTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELMA MARIE MITCHELL (LICENSEE)
(310) 532-4288
Entity
Organization
Contact information
Practice address
2512 W 134TH PL, GARDENA, CA 90249-1646
(310) 532-4288
(310) 532-6204
Mailing address
2512 W 134TH PL, GARDENA, CA 90249-1646
(310) 532-4288
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Enumeration date
05/19/2007
Last updated
08/22/2020
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