Organization
COMMUNITY RESIDENTIAL CARE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE MARIE POLK (REGISTERED NURSE)
(310) 478-3711
Entity
Organization
Contact information
Practice address
1416 W 103RD ST, LOS ANGELES, CA 90047-4510
(323) 777-0269
Mailing address
1416 W 103RD ST, LOS ANGELES, CA 90047-4510
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
483652
CA
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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