Organization
TYLER RESIDENTIAL CARE INC.
Active
Other names
None
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN TOLENTINO PENALOSA ADMINISTRATOR (PRESIDENT)
(714) 394-7652
Entity
Organization
Contact information
Practice address
6052 WESTERN AVE, BUENA PARK, CA 90621-2325
(714) 521-0140
Mailing address
525 N GUADALUPE AVE, REDONDO BEACH, CA 90277-2952
(714) 394-7652
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
306000575
CA
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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