Organization
L. MARILLAC GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE VILLEGAS (LICENSEE)
(909) 821-3698
Entity
Organization
Contact information
Practice address
23711 PROSPECT VALLEY DR, DIAMOND BAR, CA 91765-1637
(909) 821-3698
(909) 860-7614
Mailing address
23711 PROSPECT VALLEY DR, DIAMOND BAR, CA 91765-1637
(909) 821-3698
(909) 860-7614
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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