Organization
MCLENNAN AVENUE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROY L MARTIN II (PRESIDENT)
(323) 253-5316
Entity
Organization
Contact information
Practice address
12325 MCLENNAN AVE, GRANADA HILLS, CA 91344-1716
(818) 886-3172
(747) 300-9108
Mailing address
12325 MCLENNAN AVE, GRANADA HILLS, CA 91344-1716
(818) 886-3172
(747) 300-9108
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
05/30/2018
Last updated
01/16/2024
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