Organization
DELIANN-LUCILE
Active
Other names
Corporate Office
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DAVIS (CEO/FOUNDER)
(310) 215-8900
Entity
Organization
Contact information
Practice address
5800 HANNUM AVE STE A230, CULVER CITY, CA 90230-6560
(310) 215-8900
(310) 215-8907
Mailing address
5800A HANNUM AVENUE SUIT 230, CULVER CITY, CA 90230
(310) 215-8900
(310) 215-8907
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
03/15/2017
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